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PATIENT CARE PROCESS

Patient Care Process for the Management of Lung Cancer

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Collect

  • 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)

Assess

  • 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

Plan*

  • 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)

Implement*

  • 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

CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK

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

KEY CONCEPTS

KEY CONCEPTS

  • Image not available. 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 not available. 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 not available. 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 not available. 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 the optimal frequency ...

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