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Patient Care Process for the Management of Lung Cancer



  • Patient characteristics (e.g., age, race, sex)

  • Patient history (past medical, family, social—dietary habits, tobacco use)

  • Current medications and prior chemotherapy or targeted therapy

  • Symptoms of pain, pain score, pain management

  • Symptoms of venous or arterial thromboembolism

  • Clinical and objective evaluation of tumor status

  • Objective data

    • BP, heart rate (HR), height, weight, respiratory rate

    • Labs (e.g., serum electrolytes, complete blood count, Scr, BUN)

    • Histology (NSCLC squamous or nonsquamous (Table 129-1) and stage (Table 129-2)

    • Tumor markers (PD1 expression, EML4-ALK rearrangements, EGFR exon 19 or 21 mutations)


  • Type of and response to prior treatments

  • Drug therapy options given the patient's histology, stage, and tumor markers

  • Need for any dose adjustments based on renal or hepatic function or potential drug interactions

  • Side effects from current anti-cancer regimen if this is second dose or second cycle

  • Adherence to oral anti-cancer regimens


  • Goals of treatment (initial and continued)

  • Drug therapy regimen including specific oral anticancer agent, dose, route, frequency, and duration

  • Supportive care plan (e.g., antiemetics, premedications, drugs to prevent or treat constipation/diarrhea, and medications for specific drugs [folic acid and vitamin B12 for pemtrexed])

  • Patient education (e.g., purpose of treatment (curative versus palliative); side effects and how to manage)

  • Provide tools to support adherence to oral anticancer agents and supportive care medications

  • Encourage use of a diary to track pain medication and diarrhea/constipation medication use

  • Referrals to other providers when appropriate (e.g., physician, dietician, spiritual and/or psychological support, social work, nursing, palliative care or hospice)


  • Provide patient education regarding all elements of treatment plan

  • Use motivational interviewing and coaching strategies to maximize adherence

  • Schedule follow-up

Follow-up: Monitor and Evaluate

  • Presence of adverse effects

  • Measure complete blood count, renal/hepatic function, and electrolytes to determine the presence of serious side effects that warrant dose adjustments, delays, or discontinuation at next cycle

  • Inquire about pain symptoms

  • Verify patient adherence to treatment plan

*Collaborate with patient, caregivers, and other health professionals


For the chapter in the Wells Handbook, please go to Chapter 62. Lung Cancer.



  • image Lung cancer is the leading cause of cancer deaths in both men and women in the United States. The overall 5-year survival rate for all types of lung cancer is about 15%.

  • image Cigarette smoking is responsible for most lung cancers. Smoking cessation should be encouraged, particularly in those receiving curative treatment (ie, Stages I to IIIA non-small cell lung cancer [NSCLC] and limited-stage small cell lung cancer [SCLC]).

  • image NSCLC is the most commonly diagnosed type of lung cancer (about 80%). NSCLC typically has a slower growth rate and doubling time than SCLC.

  • image Annual screening with low-dose computed tomography imaging (LDCT) is currently recommended to identify lung cancer in high-risk individuals. However, several studies are evaluating ...

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