Palliative care in thoracic oncology

The vast majority of patients suffering from lung cancer are bound to die from their disease. Correspondingly, chronic or acute symptoms most often dominate the course of their disease from diagnosis to death, and are either caused by the disease itself or, sometimes, by tumour-specific therapeutic measures. Among those symptoms, pain, dyspnoea, fatigue and cough are the most frequent [1, 2]. In some European countries, lung cancer patients are mainly treated by pneumologists, including chemotherapy, or in specialised institutions (chest hospitals), which include thoracic surgery and radiotherapy units [3]. This is likely to be mainly due to the fact that frequent local complications caused by lung cancer, such as central airways obstruction, pleural effusion, pneumonia or haemoptysis, all of which require an immediate pneumological management. Consequently, pneumologists began to meet the upcoming challenge and need for palliative treatment of their patients with thoracic malignancies, as well as pneumological patients with non-malignant terminal illnesses accompanied by a high burden of symptoms [4]. In recent years, palliative care has changed from being an additional provision to tumour-specific treatment measures limited to end-of-life situations. Nowadays increasingly it has developed to being the most comprehensive treatment concept, at least for patients with incurable disease. Previously, pneumologists’ understanding of palliative care was more or less restricted to the medical treatment of disease-related symptoms [5]. Even now, such a restricted conceptual scope is perceived by some authors [6]. However, it is becoming more evident that palliative care has the potential to be the most individual, complex and thorough approach to any chronically ill patients, especially those with malignancy, who need more than medical treatment, as well as prognostically relevant or curative treatment methods specific to the tumour. This widening approach is given in table 1 …