Final stages of lung cancer: what to know

Advanced lung cancer may have moved beyond the lung to areas such as the brain, bones, liver, or the other lung. Spread to the brain is called brain metastases and can cause headaches, weakness, confusion, seizures, or changes in balance. Breathing difficulty, chest discomfort, cough, fatigue, reduced appetite, and a hoarse voice can also occur, although each person’s pattern is different.

The stage describes where the cancer is and how far it has spread; it does not describe exactly how someone will feel. Scans, examination, pathology, and sometimes genomic tumour profiling help the team understand the disease and discuss suitable options.

Ask for a treatment conversation that covers the goals of care, expected benefits, likely burdens, and what matters most to the patient. Options may include medicines such as chemotherapy, radiotherapy for a troublesome area, or a procedure when it is likely to improve comfort or function. Palliative care can be added at any stage to help with pain, breathlessness, nausea, sleep, anxiety, nutrition, and family support.

A written plan can name the medicines to use, who to call, preferred place of care, and the patient’s wishes if they become too unwell to speak. Small changes such as positioning, pacing activity, using prescribed oxygen correctly, and treating constipation can make daily life easier.

Seek urgent medical help for severe or rapidly worsening breathlessness, blue or grey lips, new confusion, a seizure, sudden weakness, coughing up a large amount of blood, severe chest pain, or inability to wake normally. Contact the oncology team promptly for fever, new pain that is not controlled, repeated vomiting, inability to drink, or a sudden change in alertness. Keep emergency numbers and the care team’s contact details easy to find.

Which symptoms are most likely to change next, and what should we do at home? What is the aim of each proposed treatment? Can palliative care visit now? Who should we call overnight? Could genomic tumour profiling affect the options? What support is available for breathing, pain, eating, sleep, and the family?