Pneumonia and cancer

ALSO KNOWN AS: Pneumonitis, bronchopneumonia, community-acquired pneumonia

RELATED CONDITIONS: pneumonia, atypical pneumonia, viral pneumonia, walking pneumonia, Legionella pneumonia, pneumocystis carinii pneumonia (PCP), other pneumonia, primary lung cancer, metastatic lung disease

DEFINITION: Pneumonia is a disease of the lungs and respiratory system in which the alveoli (air sacs) become inflamed, infected, or blocked and cannot exchange air (oxygen).

Risk factors: People with respiratory problems, older adults, children, and people with complicated health problems are more prone to pneumonia. Pneumonia usually follows a cold flu. Persons with compromised immune systems, such as acquired immunodeficiency syndrome (AIDS) patients, organ transplant patients, and cancer patients, are at risk.

Another risk factor is smoking, which can damage the cilia (microscopic hairs) that naturally sweep impurities out of the lungs. Smoke can also paralyze the cilia, allowing secretions to accumulate in the lungs. If these secretions contain bacteria, pneumonia can result.

Exposure to chemicals or other pollutants on the job or in the environment can cause lung inflammation, making it harder to clear the lungs of secretions. People in hospital intensive care units may be exposed to bacteria in the breathing tube of a mechanical ventilator.

Sometimes, a tumor will restrict or block a cancer patient’s airways, which results in the inability to clear secretions from the lungs. This can predispose the patient to pneumonia. Other risk factors for the cancer patient include radiation therapy, chemotherapy, steroids, malnutrition, surgery, neutropenia (depressed white cell count), limited mobility, antibiotics, and splenectomy, which results in immune-system problems.

Etiology and the disease process: Pneumonia can be caused by bacteria, fungi, viruses, or chemical and physical damage such as inhalation of toxins and cancer. When a person breathes, the air passes through the trachea (windpipe) to the lungs, which branch into bronchi tubes. The bronchi divide into smaller narrow tubes called bronchioles, leading to small saclike alveoli (air sacs). The function of the alveoli is to exchange gases (oxygen and carbon dioxide) with the blood capillaries. In pneumonia, these alveoli become inflamed or blocked so that oxygen and carbon dioxide exchange is diminished. How severely this exchange is restricted depends on the underlying cause of the pneumonia and the patient's overall health.

Incidence: Nearly twenty-five of every 100,000 Americans develop pneumonia each year. Pneumonia and influenza (together) are a deadly combination for many individuals each year. Pneumonia claims over 40,000 lives annually. About 50 percent of all pneumonia is caused by respiratory viruses. Streptococcus pneumoniae (pneumococcus) is the most common pneumonia-causing bacterium.

Symptoms: When people have bacterial pneumonia, they experience difficulty breathing, have shallow, rapid breathing, and may have a productive cough. Their cough may produce greenish or yellow sputum (phlegm) or sometimes blood-tinged sputum. Patients with bacterial infections usually experience shaking, chills with fever, and sharp chest pain that worsens when coughing or breathing deeply. Patients with viral pneumonia exhibit more flu-like symptoms, such as a dry cough, headache, muscle pain, fever, and fatigue. The cough may produce a small amount of clear or white sputum. Viral pneumonia can become bacterial pneumonia (a secondary infection) under the right conditions. Other symptoms include headache, loss of appetite, severe fatigue, sweating and clammy skin, and sometimes mental confusion in older adults.

Screening and diagnosis: Diagnosis is made by physical examination and listening to the sound of the breath (such as crackles) through a stethoscope. The healthcare provider usually orders a chest X-ray and reviews the scan for consolidations (white or opaque areas) that represent infected or blocked areas. Sometimes, pneumonia is difficult to visualize with an X-ray, so computed tomography (CT) is used. Other procedures that help diagnose pneumonia include pulse oximetry and a pleural fluid culture.

The healthcare provider may request a culture of the sputum (Gram-staining procedure) to isolate the causal bacteria and confirm that the bacteria are sensitive to the prescribed antibiotic. A complete blood count test will allow the provider to monitor elevated white cell counts that can indicate bacterial disease. Blood tests for specific organisms may be needed to further define the cause of the pneumonia. In severe cases, arterial blood gases may help assess blood oxygenation.

If the pneumonia is severe and not responding to treatment, the diagnostic healthcare provider may also use a bronchoscope (flexible tube) to examine the lungs for swelling, inflammation, obstruction, or a tumor.

Treatment and therapy: Pneumonia is treated based on the cause of the disease. Antibiotics are used to treat bacterial pneumonia but are useless for viral pneumonia. Strains of bacteria that are resistant to antibiotics are making the treatment of pneumonia a challenge. Most people can be treated at home unless they have underlying chronic diseases such as cancer or are older adults or very young. In these cases, hospitalization is necessary to stabilize the person with intravenous antibiotics, fluids, and possibly oxygen therapy. Occasionally, steroid drugs must be used to decrease inflammation or wheezing.

If a patient is allowed to recuperate at home, the healthcare provider will encourage increased fluid intake to loosen the lung secretions and allow the patient to expectorate (spit out) phlegm. The key to recovery is rest and symptom control, such as managing fever with acetaminophen or aspirin (no aspirin in children).

Sometimes, postural drainage is ordered for patients who need help removing phlegm. With assistance, the patient will lean over the side of the bed with the head down and allow gravity to drain the lungs. Those assisting can gently but firmly pound the patient’s upper back to dislodge mucus mechanically. This can be done for about five to fifteen minutes, three times a day, or as tolerated by patients.

Treatment for cancer patients with pneumonia must be aggressive and prompt. Bed rest and medications to expel phlegm to clear the airways may be prescribed. The healthcare provider must choose treatment approaches that complement the therapy that patients are receiving for their cancer so as not to decrease the immune response.

Alternative or complementary treatments offer no cure for pneumonia but may provide some symptom relief. Acupuncture can relieve congestion and may improve generalized fatigue. Some people benefit from a warm bath or room vaporizer using either plain, distilled water or distilled water with essential oils like eucalyptus added. People with asthma should avoid heat inhalations, as these can irritate sensitive lung tissue.

Other complementary treatments include massaging the upper back, taking homemade cough syrup of honey and other natural ingredients, and drinking echinacea herbal tea. Supplements such as zinc or vitamins A, C, and E may support the immune system.

Prognosis, prevention, and outcomes: Pneumonia can range in severity from mild to severe to fatal, depending on the cause, age, and health of patients. With adequate treatment of the cause, most pneumonia patients will show improvement within about two weeks. If patients have other compromising diseases, such as cancer, recovery may be slower. If patients fail to respond to treatment, they may die of respiratory failure.

Prevention is especially important for patients with cancer or infected with the human immunodeficiency virus (HIV). Measures to prevent infection include frequently washing hands after blowing the nose or coughing, going to the bathroom, diapering a baby, and before and after food preparation. Immune-compromised people should avoid contact with anyone who has a cold or flu or has been exposed to these illnesses. They should also use a protective mask when cleaning to decrease exposure to dust and molds. The influenza and pneumonia vaccines may also be options and should be checked out with a healthcare provider.

Bibliography

Fujimoto, Kazushi, et al. "KRASG12C Inhibitor as a Treatment Option for Non-Small-Cell Lung Cancer with Comorbid Interstitial Pneumonia." Cancers, vol. 16, no. 7, 2024, p. 1327. doi.org/10.3390/cancers16071327.

File, Thomas. Community-Acquired Pneumonia: Controversies and Questions. Elsevier, 2013.

Goldblum, John R. Pulmonary Pathology E-Book. Elsevier Health Sciences, 2024.

Grippi, Michael A. Fishman’s Pulmonary Diseases and Disorders. 6th ed., McGraw-Hill Education LLC., 2023. 

Ikeda, Satoshi, et al. "Current Treatment Strategies for Non-Small-Cell Lung Cancer with Comorbid Interstitial Pneumonia." Cancers, vol. 13, no. 16, 2021. doi.org/10.3390/cancers13163979.

Kamada, Teppei, et al. "Association Between Masseter Muscle Sarcopenia and Postoperative Pneumonia in Patients with Esophageal Cancer." Scientific Reports, no. 12, vol. 1, 2022, doi.org/10.1038/s41598-022-20967-1.

Sagar, A.E.S., Evans, S.E. "Pneumonia in the Cancer Patient." Nates, J., Price, K. Oncologic Critical Care. Springer, 2019, pp. 607-623. doi.org/10.1007/978-3-319-74588-6‗53.

Slivinski, Natalie. "Lung Cancer and Pneumonia: What to Know." Web MD, 28 Aug. 2022, www.webmd.com/lung/lung-cancer-pneumonia. Accessed 20 July 2024.

Tanaka, Shiori, et al. “Increased Risk of Death from Pneumonia among Cancer Survivors: A Propensity Score‐matched Cohort Analysis.” Cancer Medicine, 2022, pp. 6689–6699, doi.org/10.1002/cam4.5456.

Wong, Justin L., and Scott E. Evans. “Bacterial Pneumonia in Patients with Cancer: Novel Risk Factors and Management.” Clinics in Chest Medicine, vol. 38, no. 2, 2017, pp. 263-277. doi:10.1016/j.ccm.2016.12.005