Mariken Stegmann

Netherlands there is no lung cancer screening program. Treatment of lung cancer is highly dependent on the cancer stage at diagnosis. Most patients with early stage lung cancer are surgically treated (73% stage I; 55% stage II). 4 Most patients in stage III are treated with chemotherapy (47% stage III, 44% stage IV), sometimes combined with radiotherapy. Targeted therapy and immunotherapy are fast growing treatment modalities for patients with stage III or IV lung cancer. 9 Lung cancer is the most frequent cause of death from cancer in Europe (20% of the total). 1 In the Netherlands, the five years survival rate after diagnosis is 20%. 8 Symptoms during diagnosis and treatment A cancer diagnosis often has a lot of impact, both physical and psychosocial. Almost all patients with cancer experience physical symptoms. 10 Apart from the above mentioned disease specific diagnostic symptoms (e.g. rectal bleeding), most patients during therapy and living with cancer experience general symptoms like fatigue and pain. Cancer not only leads to physical symptoms, but often also causes distress. The American national comprehensive cancer network defines distress as “a multifactorial unpleasant emotional experience of a psychological (cognitive, behavioural, emotional), social and/or spiritual nature.” 11 Of all cancer patients, 20 ‐ 50% shows a significant level of distress. 11 Symptoms of anxiety and depression are the most commonly reported forms of distress. Unfortunately, the prevalences of both physical and distress symptoms in older palliative patients are often unknown. Physical symptoms Fatigue is the most frequent symptom during medical treatment. 12 Depending on the definition and method of measurement, 40 to 100 percent of all patients with cancer are estimated to experience fatigue. 10 For patients with incurable cancer a systematic review calculated a pooled prevalence of 74% (95% CI 63 ‐ 83). 13 Other studies reported lack of energy (pooled prevalence 69%) or weakness (pooled prevalence 60%), which can be seen as variants of fatigue. The cause of cancer related fatigue is thought to be multifactorial. 10 Part of the etiology are tumour ‐ related factors like anemia, electrolyte abnormalities, anorexia, hypoxia and fever. 10 Comorbid conditions, e.g. heart failure, and side effects of medication, e.g. beta blockers, can also cause or increase fatigue. Lastly, anxiety, depression and sleep disorders, also common in patients with cancer, are associated with fatigue. 10 Cancer related fatigue is difficult to manage and mainly consists of treatment of the underlying factors. 10 Many patients with cancer experience pain. The pooled prevalence of pain for patients during cancer treatment was calculated as 55% (95% CI 45.9 ‐ 64.2) 14 and 66 ‐ 71% for patients with incurable cancer. 13,14 Cancer related pain is mostly (70%) caused by tumour growth at the primary site or in metastases. 15 However, problems like obstipation and decubitus can also cause pain. 15 Psychosocial factors are thought to influence pain experience as well. 14 Most cancer related pain can be treated effectively with pain killers or radiotherapy. 15 Patients with cancer can experience a wide range of other physical symptoms. Frequently reported ones are weight loss, dry mouth, dyspnea, nausea, bloating, cough, cognitive symptoms, taste changes, sore mouth, vomiting and drowsiness. 13 124