Palliative Care for Metastatic NSCLC: Is It Right for You?

Of course being diagnosed with metastatic non-small cell lung cancer (NSCLC) feels overwhelming. Between juggling treatments, managing symptoms and side effects, and dealing with the anxiety of a stage 4 cancer diagnosis, it’s a lot to process. That’s where palliative care comes in.

People often confuse palliative care with end-of-life or hospice care. But palliative care doctors and their interdisciplinary team work alongside your cancer treatment team to manage symptoms, reduce side effects, address your goals, and provide emotional support.

“Getting a palliative care team involved early allows us to address any symptoms you are having currently and to start building a relationship,” says Jessica Kaltman, MD, an outpatient palliative care physician at UCLA Extensivist and Palliative Care in Santa Monica. “That’s really helpful as we move forward in your trajectory with NSCLC.”

Palliative Care Treatments for Metastatic NSCLC

• Medications to treat symptoms
• Procedures to open airways
• Oxygen tanks
• Mental health resources
• Nutritional supplements or advice
• Complementary therapies, such as meditation
• Spiritual guidance

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• Additional education about your cancer or treatment options

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Metastatic NSCLC is a systemic disease, meaning it can affect your whole body. So you need an interdisciplinary team of specialists to support you.

• Palliative Care Physician While a traditional physician focuses on diagnosing and treating health concerns, a palliative care physician specializes in helping to address the goals of care, ease suffering, and promote overall quality of life. They do so by working with the rest of the palliative care team to manage the physical symptoms and treatment side effects, as well as the psychological aspects, such as depression or isolation.
• Social Worker or Counselor Nurses and respiratory therapists primarily handle physical symptoms, while a social worker or counselor can offer psychological support. They can help you cope with any stress and anxiety as you go through treatment.
• Pharmacist Your pharmacist will not only fill your prescriptions, but also help you get medications that are difficult to obtain. They can even offer advice on managing treatment side effects.
• Nurse or Nurse Navigator Kaltman says a nurse navigator is one of the most important members of a palliative care team. They work as a liaison with the rest of the team to help oversee your care and continuously monitor your symptoms, track hospitalizations, follow up on treatment goals, and provide support and instructions to your caregivers. If you’re experiencing any new symptoms or need a new medical device, your nurse navigator will make sure you’re getting everything you need. They can also help you overcome treatment barriers, such as transportation issues.

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• Chaplain A chaplain can offer support through the lens of your spiritual beliefs to help you cope.

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Some people meet with additional palliative care specialists to address specific needs.

• Respiratory Therapist or Pulmonologist Kaltman notes that a respiratory therapist is more likely to be part of your inpatient care team but can also help improve lung function with a variety of palliative treatments. So can a pulmonologist. For instance, these specialists can drain fluid around your lungs if necessary and teach you techniques for breathing more easily.
• Registered Dietitian Dietitians are increasingly becoming part of holistic palliative care, says Kaltman. Many cancer treatments can take away your appetite, causing you to lose weight. A dietitian can suggest ways to boost your calorie intake, such as supplemental nutrition shakes, or even advise you on medications that may stimulate your appetite.
• Care Coordinator This specialist handles intake when you first begin palliative care and helps with logistics such as appointments, insurance, and transitioning to hospice care if you need it.

“We try to look at the whole person and make sure that their values and their goals match the medical care that they’re receiving,” Kaltman says. Combined, these palliative care specialists can help by:

• Establishing a supportive relationship, so you can rely on them as a trusted resource
• Addressing current symptoms while anticipating and managing future treatment-related side effects. This may include procedures that treat fluid buildup around the lungs and heart or radiation to shrink tumors that block airways.

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• Offering emotional, social, and even spiritual support
• Providing continuous guidance as you and your caregivers navigate your NSCLC journey

You can get palliative care in all sorts of settings, from the hospital and outpatient clinics to the comfort of your own home with telehealth visits. “Video visits have really been a game changer that has increased palliative care access for patients,” Kaltman says.

Depending on your needs and preferences, sessions may be scheduled regularly, such as weekly or every two weeks if you have many side effects, or on an as-needed basis.

Kaltman’s team often schedules visits in conjunction with oncology appointments to reduce the stress of transportation and minimize the number of times you have to leave your home if you’re not feeling well.

Your palliative care team will work with you to create a schedule that’s right for you.

If you’re considering palliative care for metastatic NSCLC, the first step is to discuss it with your oncologist. They can provide information, recommendations, and referrals to palliative care services in your area.

You can also contact a palliative care office and let them know you’re interested in a referral.

Health insurance companies may offer resources and coverage for these services, so search your company’s website to see if in-network palliative care services are covered by your plan.

In addition to the physical interventions, emotional support, and even spiritual guidance when you’re trying to handle an overwhelming diagnosis such as metastatic NSCLC, palliative care “might also give you a little more energy to enjoy time with your family or be able to do some more activities around the home,” says Kaltman. “That makes a huge impact.”

Not to mention, it can help you feel supported and understood. “It’s a space to feel heard and discuss your biggest worries and fears in a way that is not available otherwise,” Kaltman says. “I often have patients say to me at the end of a visit, ‘I’ve gotten a lot off my mind, and I just feel better.’”

• Palliative care isn't the same as hospice care or end-of-life care.
• Palliative care for metastatic NSCLC is a combination of physical interventions, emotional support, and spiritual guidance that can improve a person's prognosis and quality of life.
• Talk to your oncologist if you’re interested in palliative care. It’s recommended to start as soon as possible after your metastatic lung cancer diagnosis, but it’s never too late.