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Pneumonia Health Article

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Description

One of the most common pulmonary complications affecting cancer patients, pneumonia is a potentially life-threatening inflammation of one or both lungs.

Causes

Serious side effects in cancer patients most often occur in the lungs and may indicate that the cancer is progressing or that the patient has developed a new problem. Both cancer and the therapies used to treat it can injure the lungs or weaken the immune system in ways that make cancer patients especially susceptible to the bacteria, fungi, viruses, and other organisms that cause pneumonia.

Tumors and infections can block the patient's airway or limit the lungs' ability to rid themselves of fluid and other accumulated secretions that make breathing difficult. Other factors that increase a cancer patient's risk of developing pneumonia include:

radiation therapy
chemotherapy
surgery
depressed white blood cell count (neutropenia)
antibiotics
steroids
malnutrition

limited mobility

splenectomy -immune system deficits

The risk of developing pneumonia is greatest for a cancer patient who has one or more additional health problems.

Treatments

Pneumonia in cancer patients must be treated promptly in order to speed recovery and prevent complications that could arise if the inflammation were allowed to linger. Treatment always includes bed rest and coughing to expel phlegm and other fluids from the lungs (productive cough). To determine which course of treatment would be most appropriate, a doctor considers when symptoms first appeared, what pattern the illness has followed, and whether cancer or its treatments have diminished the patient's infection-fighting ability (immune response).

A doctor generally prescribes broad-spectrum oral antibiotics if:

the patient has had a fever for less than a week
pneumonia has not spread beyond the lung area where it originated
the patient's cancer is responding to treatment
the patient is otherwise in good health

The doctor uses a flexible tube (bronchoscope) to examine the lungs and airway (bronchoscopy) for inflammation, swelling, obstruction, and other abnormalities and washes the lungs (bronchoalveolar lavage) with a mucus-dissolving solution if:

pneumonia is extensive, aggressive, or severe
antibiotics don't clear the infection
the patient is very ill

The doctor may also remove a small piece of lung tissue (transbronchial biopsy) for microscopic examination and cultures, and prescribe medication to combat fungal and viral organisms that might be responsible for the patient's symptoms. If the patient's condition continues to worsen, the doctor may remove additional lung tissue (thoracic needle biopsy or open lung biopsy) for microscopic analysis and cultures.

Alternative and complementary therapies

Non-medical treatments will not cure pneumonia but may relieve symptoms and make the patient more comfortable. All of these therapies require the treating doctor's approval.

ACCUPUNCTURE.

Accupuncture may relieve congestion and reduce fatigue.

ESSENTIAL OILS.

Added to a warm bath or vaporizer, essential oils of eucalyptus (Eucalyptus globus), lavender (Lavandula officinalis), or pine (Abies sibirica) can create a fragrant steam that helps the patient breathe more easily. Because steam inhalations can irritate the lungs, individuals who have asthma should not use them.

POSTURAL DRAINAGE.

A strenuous exercise that can help clear phlegm from the lungs, postural drainage should be practiced only with a doctor's approval and in the presence of a person who can provide support for a patient who becomes tired or weak.

Leaning over the side of the bed with forearms braced on the floor, the patient coughs up phlegm and spits it into a container. If the patient cannot cough productively enough to dislodge phlegm, the support person can help clear lung secretions by pounding gently on the patient's upper back. Postural drainage should be performed three times a day. Each session should last between five and 15 minutes, unless the patient tires or weakens sooner.

MASSAGE.

After the patient's fever has broken, gently massaging the upper back may relieve congestion and encourage productive cough.

HERBAL REMEDIES.

Homemade cough medicines (expectorants) containing licorice (Glycyrrhiza glabra), black cherry (Prunus serotina) bark, raw onions, honey, and other natural ingredients can relieve congestion and encourage productive cough. Because natural substances can be poisonous, they should be used only with a doctor's approval and according to label directions.

Eating raw garlic (Allium sativum) or taking garlic supplements is believed to strengthen the immune system. Echinacea, brewed as tea or taken in liquid or capsule form, may help some patients recover more quickly.

VITAMINS.

Zinc supplements and large doses of Vitamins A, C, and E may strengthen the patient's immune system. Because large doses of some vitamins can cause diarrhea and other serious side effects, they should not be taken without a doctor's approval. Additionally, large doses of vitamins and herbal remedies may interfere with the primary cancer treatment programs. Approval from the treating doctor is imperative.

Resources

BOOKS

Ito, James, MD. "Infectious Complications." In Cancer Man agement: A Multidisciplinary Approach, 4th ed. Pazdur, R., et al, eds. New York: PRR Inc., 2000.

Stockdale-Wooley, R., and L. Norton. "Pulmonary Function." In Handbook of Oncology Nursing, 3rd ed. Johnson, B., and J. Gross, eds. Sudbury, MA: Jones and Bartlett Pub lishers, 2001.

PERIODICALS

Bergen, G.A., and J.H. Shelhamer. "Pulmonary Infiltrates in the Cancer Patient: New Approaches to an Old Problem." Infectious Disease Clinics of North America 10 (1996): 297-325.