“Of all the eight different pulmonary toxicities you and I have talked about over these two different podcasts, they’re all very different etiologies and treatments. So, we went everywhere from infection and good stewardship with antibiotics to pulmonary GVHD to diffuse alveolar hemorrhage. And I think that’s what’s the hardest part for us as nurses. It’s not just one thing that’s causing it, and there’s multiple different ways to treat these things,” Beth Sandy, MSN, CRNP, thoracic medical oncology nurse practitioner at the Abramson Cancer Center at the University of Pennsylvania in Philadelphia told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about pulmonary toxicities in cancer treatment.

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0 

The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center’s Commission on Accreditation.

Learning outcome: Learners will report an increase in knowledge related to pulmonary complications in people with cancer.

Episode Notes 

• The NCPD activity for this episode has expired, but you can still earn NCPD through many other ONS Podcast episodes. Find a full list of opportunities.
• Oncology Nursing Podcast episodes:
  • Episode 295: Cancer Symptom Management Basics: Pulmonary Embolism, Pneumonitis, and Pleural Effusion
  • Episode 212: When Cancer Care Gets Complex: Those Other Oncologic Emergencies
  • Episode 206: Graft-Versus-Host Disease: Biomarkers and Beyond
  • Oncologic Emergencies 101 series
• ONS Voice articles:
  • Pneumonitis With Immunotherapy Treatment
  • The Case of the Post-Transplant Pulmonary Problem
  • How Inhaled Cannabis May Contribute to Pulmonary Toxicity in Patients With Cancer
• ONS courses:
  • Essentials in Oncologic Emergencies for the Advanced Practice Provider
  • Oncologic Emergencies
  • Treatment and Symptom Management—Oncology RN
• ONS books:
  • Understanding and Managing Oncologic Emergencies: A Resource for Nurses (third edition)
  • Clinical Manual for the Oncology Advanced Practice Nurse (fourth edition)
• Clinical Journal of Oncology Nursing article: Influenza Adherence Tool Kit: Implementation and Evaluation Among Allogeneic Hematopoietic Transplantation Recipients
• Oncology Nursing Forum articles:
  • Community Respiratory Virus Infection in Hematopoietic Stem Cell Transplantation Recipients and Household Member Characteristics
  • Emergence of Stereotactic Body Radiation Therapy
  • Multifactorial Model of Dyspnea in Patients With Cancer
• ONS Huddle Cards:
  • Hematopoietic Stem Cell Transplantation
  • Proton therapy
  • Radiation
  • Sepsis
• ONS Guidelines™ and Symptom Interventions: Dyspnea
• American Cancer Society patient resources:
  • Shortness of Breath
  • Infections in People With Cancer
• American Lung Association

To discuss the information in this episode with other oncology nurses, visit the ONS Communities.

To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library.

To provide feedback or otherwise reach ONS about the podcast, email [email protected].

Highlights From This Episode

“[Intensity-modulated radiation therapy] is a type of radiation that can really take into account certain movements. And this is particularly important with the lungs, because we can’t necessarily have patients hold their breath for a long period of time, so the chest rises and falls and the heart beats while you're trying to do radiation to the lungs. So with IMRT, they can simulate that, so that the beam is going to follow that specific movement in that patient. That’s really helpful because then, hopefully, we’re going to keep that radiation dose mostly on cancer tissue and not on healthy tissue. And thus, that should reduce the amount of radiation that’s to the healthy tissue and hopefully reduce pneumonitis.” TS 3:44

“Proton beam radiation is something that we’ve described in the past as radiation that will typically have an entrance dose but not an exit dose, so minimizing toxicity by hopefully around 50%. … If you’re doing proton beam therapy, that radiation is designed to only have an entrance dose from either the back or the front or the side, whichever way they’re going, but then hopefully stop on a dime at that tumor so that they’re only really getting the entrance dose of that radiation. … So in turn, especially if you’re doing that to the lungs, that should minimize dose of radiation to healthy lung tissue.” TS 5:03

“If they’re having a fever, low blood count, thick ugly mucus, this often, typically can be infection as well. And then get a chest x-ray because, a lot of times I’ve been saying for a lot of these things, we need a CT scan to see this. Actually, infection is probably best noted on a chest x-ray because this is something that will consolidate.” TS 18:58

“[Tumors] may be directly invading a vessel. They may directly be invading the bronchus where there’s a lot of capillaries or there’s a lot of blood vessels that can break and then cause them to cough up blood. You can have tumors or prior treatment that then cause a bronchial fistula that then can cause bleeding. Patients with squamous cell carcinoma of the lung are much more likely to have hemoptysis and pulmonary hemorrhage than patients with adenocarcinoma, though it definitely can happen with adenocarcinoma as well.” TS 22:00

“One of the best treatments for tumor-direct hemorrhage is radiation. This is where radiation can be very helpful for these patients. It’s one of the first things that we do. We’re going to go in with radiation, shrink that tumor really fast to get it away from those vessels, so patients stop bleeding.” TS 27:17