My name is Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care. And here at intensivecarehotline.com, we instantly improve the lives for families of critically ill patients in intensive care so that you can make informed decisions, have peace of mind, control, power, and influence so that your loved one always gets best care and treatment, even if you’re not a doctor or a nurse in intensive care.

I’m a critical care nurse with over 25 years ICU critical care nursing experience in three different countries, where I worked as a nurse manager for over five years in ICU and I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives for our clients in intensive care. You can verify that on our testimonial and podcast section where we have collected client testimonials, and we have done client interviews.

So today I’m answering a question from Patty, whose husband has been newly diagnosed with advanced non-small cell lung cancer in the ICU.  Patty wants to know how she can be sure her husband is being correctly diagnosed and treated. This is one of the most important questions any family member can ask, and I’m going to give you a detailed answer.

Patty’s Question:

“Hi Patrik.

My husband has been newly diagnosed with non-small cell lung cancer, also known as NSCLC, with worsening respiratory symptoms with diffuse bone, brain and liver metastases, including cervical pathological fracture, pericarditis, and small pericardial effusion. Several tests, diagnostic procedures, imaging studies, X-rays, and surgical biopsies have been done. My question is, how will I know that my husband is correctly diagnosed and being treated correctly for his diagnosis? What are the tests, investigations and procedures needed to confirm my husband has non-small cell lung cancer, NSCLC? Please name and explain the things that can be done to treat my husband from the NSCLC.”

From Patty

Patty, thank you so much for reaching out. I can only imagine how overwhelming and frightening it must be to have your husband in ICU with a diagnosis this serious. Advanced non-small cell lung cancer with metastases to the brain, bones, and liver, on top of a cervical pathological fracture, pericarditis and a pericardial effusion. That is a lot to process, and your instinct to question and advocate for your husband is absolutely the right instinct.

Before I get into the specifics of tests, investigations and treatment options, I want to say something very important. You have every right to understand what is happening to your husband, to ask questions, to request explanations, and to get answers in plain language. You also have every right to access all of your husband’s medical records, and I strongly encourage you to do exactly that right now.

Step One: Get Access to All the Medical Records

Request access to all of your husband’s medical records. This includes:

• All imaging studies: CT (Computed Tomography)  scans, MRI (Magnetic Resonance Imaging) scans, PET (Positron Emission Tomography) scans, X-rays, and bone scans
• Pathology and biopsy reports, including the histology, molecular profiling, and genomic testing results
• Blood test results: full blood count, liver function tests, kidney function, tumor markers
• Echocardiogram reports given the pericarditis and pericardial effusion
• Neurology assessments given the brain metastases and cervical pathological fracture
• All multidisciplinary team meeting notes and treatment plans
• Nursing notes and ICU progress notes
• Ventilation charts, vital sign charts, fluid balance charts

Why does this matter so much? Because when you have access to the actual medical records, not just verbal summaries, you can see exactly what has been done, what has been found, and what the plan is. You can also share those records with an independent expert like me and my team at intensivecarehotline.com, who can review them with you and help you ask the right questions .

Many families tell me they feel like they’re only getting parts of the picture. That changes when you have the records in hand and you have an independent consultant look at it.

If you would like me and my team to conduct a consulting call with you and your husband’s ICU team whilst we look at the medical records, please contact us at intensivecarehotline.com, call us on one of the numbers on the top of our website or send us an email to [email protected].

When requesting access to medical records, never overcomplicate it. A lot of families think requesting access to medical records is a big deal. It’s not. In 2026, you should be able to get access to medical records at the drop of a hat. The hospital should give you access to medical records through a website URL with a username and a password, or through an app with a username and a password.

It’s 2026. Any delays in you getting access to the medical records should concern you. You should be asking the question: What do they have to hide?

Just today, for example, I was talking to a client who has their daughter in ICU and she’s been ventilated for five weeks in ICU and today was the very first time they even heard about a tracheostomy. The longer you wait, the more issues will come up, and it’s life and death.

The biggest challenge for families in intensive care is simply that they don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights, and they don’t know how to manage doctors and nurses in intensive care.

Step Two: How Is Non-Small Cell Lung Cancer Diagnosed?

Let me explain what tests and investigations are needed to properly confirm a diagnosis of NSCLC and understand how advanced it is, because Patty, you asked exactly the right question.

Non-small cell lung cancer is a broad term that covers the most common types of lung cancer. The three most common subtypes are:

Adenocarcinoma, the most common type, especially in non-smokers.
Squamous cell carcinoma, strongly associated with smoking.
Large cell carcinoma, a less common subtype.

The reason this matter is that the subtype determines which treatments will work, and in 2025, molecular profiling has completely changed how NSCLC is treated.

Key Diagnostic Tests:

Imaging Studies:

• CT scan of the chest, abdomen and pelvis to map the primary tumor and look for metastases
• MRI of the brain to confirm and characterize brain metastasis
• PET CT scan to assess metabolic activity of the tumor and identify all sites of spread
• Bone scan or PET to evaluate bone metastases, including the cervical fracture
• Echocardiogram, critically important given the pericarditis and pericardial effusion to assess heart function and fluid around the heart

Tissue Biopsy and Pathology:

• Biopsy of the primary lung tumor. This is essential and may be done via bronchoscopy, CT guided biopsy or surgical biopsy
• Histological analysis to confirm the cell type: adenocarcinoma, squamous cell, etc.
• Immunohistochemistry to look at specific protein markers on the tumor cells
• Molecular and genomic profiling—this is critical and I will explain more below

Molecular and Genomic Testing—The Game Changer in NSCLC:

This is one of the most important things, Patty, I want you to understand and push for if it has not already been done. In 2025, molecular profiling is not optional for advanced NSCLC. It is standard of care. Your husband’s tumor tissue should be tested for the following genetic mutations and markers because each one changes the treatment:

• EGFR (Epidermal Growth Factor Receptor) mutation: If positive, targeted therapy with EGFR inhibitors, i.e., Osimertinib, is highly effective
• ALK (Anaplastic Lymphoma Kinase) rearrangement: If positive, ALK inhibitors such as Ectinib, Alectinib are the treatment of choice
• ROS1 (Reactive Oxygen Species Inhibitors) rearrangement: Treated with specific targeted inhibitors
• KRAS (Kristen Rat Sarcoma) G12C mutation: There are now approved targeted therapies for this mutation
• BRAF (B-Raf proto-oncogene) V600E mutation: Targeted combination therapy is available
• MET (Mesenchymal-Epithelial Transition) exon 14 skipping: Treated with MET inhibitors
• RET (Rearranged during Transfection) rearrangement: RET inhibitors are available
• PD-L1 (Programmed Death-Ligand 1) expression: Determines eligibility for immunotherapy
• TMB (tumor mutational burden): Also informs immunotherapy response

Additionally, liquid biopsy, a blood test looking for circulating tumor DNA, can be used alongside tissue biopsy to detect mutations, particularly if there is insufficient tissue from the biopsy.

Ask the ICU team and the oncology team:

• Has comprehensive molecular profiling and PD-L1 testing been done?
• Has the tumor been referred to a multidisciplinary oncology team for discussion?

These are the non-negotiables for advanced NSCLC in 2025, 2026.

Treatment Options for Advanced NSCLC—What Can Be Done for Patty’s Husband?

Patty, I want to be honest with you, while also giving you hope. Your husband’s situation is very serious. Stage 4 NSCLC with brain, bone, and liver metastasis, a cervical pathological fracture, pericarditis, and a pericardial effusion is a complex clinical picture. But there are treatment options, and the right treatment depends on the molecular profile of the tumor.

Number One, Targeted Therapy:

If your husband’s tumor has a driver mutation such as the ones I mentioned before, targeted therapy is likely to be the most effective first line treatment. These are oral tablets or capsules that specifically block the cancer’s growth mechanism. They work better and have fewer side effects than traditional chemotherapy for patients with these mutations.

For example, Osimertinib, also known as Tagrisso, for EGFR mutant NSCLC has shown remarkable results even in patients with brain metastases because it crosses the blood-brain barrier effectively.

Number Two, Immunotherapy:

If the tumor has high PD-L1 expression, 50% or more, immunotherapy with Pembrolizumab as a single agent may be the preferred first line treatment even without a driver mutation. Immunotherapy works by helping your husband’s immune system recognize and attack the cancer cells. For patients with lower PD-L1 expression or no driver mutation, combination chemo-immunotherapy—chemotherapy plus Pembrolizumab or another checkpoint inhibitor—is often recommended.

Number Three, Chemotherapy:

Platinum-based chemotherapy, typically carboplatin or cisplatin combined with pemetrexed for non-squamous NSCLC or gemcitabine, Paclitaxel for squamous cell remains an important option. It is especially used when there is no driver mutation and when combined with immunotherapy. However, given your husband’s current clinical condition in ICU, the team will need to carefully assess whether he’s well enough to tolerate chemotherapy at this point.

Number Four, Radiation Therapy:

Radiation plays an important role in several aspects of your husband’s care:

• Stereotactic radiosurgery or whole brain radiation for brain metastasis
• Stereotactic body radiotherapy for the primary lung tumor or limited metastatic sites
• Radiation to the spine, cervical vertebrae, important to stabilize the pathological fracture and protect the spinal cord from compression

Management of the Cervical Pathological Fracture:

This is urgent and cannot be overlooked. A cervical pathological fracture—a fracture of the neck vertebrae caused by the cancer—carries a real risk of spinal cord compression, which can cause paralysis. Your husband’s team must involve a neurosurgeon and or an orthopedic spine surgeon to assess whether surgical stabilization is needed or whether radiation alone is sufficient. He may also need a cervical collar or orthotic support in the meantime.

Management of Pericarditis and Pericardial Effusion:

The pericarditis, inflammation of the sac around the heart, and pericardial effusion, fluid around the heart, need to be closely monitored. If the effusion becomes large enough to compress the heart, a condition called cardiac tamponade, it becomes a life threatening emergency requiring pericardiocentesis—draining the fluid with a needle. The cardiology team should be actively involved in your husband’s care.

Palliative Care—Not the End, But Essential From Day One:

I want to say something that is often misunderstood. Palliative care is not about giving up. Palliative care is about managing symptoms, controlling pain, and improving quality of life, and it should be integrated alongside all active treatment from the very beginning in advanced cancer. If your husband is experiencing pain from bone metastasis, breathlessness, nausea, or any other symptoms, the palliative care team should be involved now.

My strong recommendation, Patty, is that your husband’s care is being managed by a full multidisciplinary team, including medical oncology, radiation oncology, neurosurgery, cardiology, respiratory medicine, palliative care and the ICU team. A consulting call with my team at intensivecarehotline.com will help you confirm this is happening, ask the hard questions, and advocate for your husband.

What About Long-Term Care? Could Home Ventilation Be an Option?

Given your husband’s worsening respiratory symptoms, Patty, in the context of advanced NSCLC, there is a real possibility that he may need ongoing ventilation support. Either invasive ventilation with a tracheostomy, non-invasive ventilation such as BiPAP, CPAP, APAP, VPAP, or he might need high flow nasal prongs.

If that is the case, I want you to know that life outside of ICU on a ventilator is possible. I’m also the founder of Intensive Care at Home. You can find more information at intensivecareathome.com.

With Intensive Care at Home, we provide home care nursing for long-term ventilated adults and children with tracheostomies or without tracheostomies, ventilation or tracheostomy without ventilation. This includes palliative care, IV therapy at home. Anything that can be done in an ICU can be done at home with some exceptions. As long as patients are stable, they can be taken home from ICU directly.

You can find more information at intensivecareathome.com. We offer a genuine alternative to a long-term stay in intensive care, predominantly for long-term ventilated adults and children with tracheostomy or invasive or non-invasive ventilation such as BiPAP or CPAP, or for tracheostomy without ventilation and home TPN, IV fluids, etc.

We are third-party accredited.  We are currently operating all around Australia, in all major capital cities and in all regional and remote areas in all states and territories. If you’re watching this in the US or in the UK, please also check out intensivecareathome.com because we can help you in the US and in the UK as well.

The model of care for Intensive Care at Home is designed to keep patients out of the ICU predictably and permanently, providing the same level of specialist critical care nursing in the comfort of our client’s own home surrounded by family. For a patient like your husband, where the trajectory of illness may involve increasing respiratory support, planning ahead for home-based care is not just compassionate. It is also clinically and financially sensible. The cost of long-term ICU stay by far exceeds the cost of specialist home care nursing.

You can learn more about Intensive Care at Home by going to www.intensivecareathome.com. You can also look up our evidence-based mechanical home ventilation guidelines there, and you can look up our third-party accreditation for Intensive Care at Home nursing.

How Can We Help Patty and Her Family Right Now with Intensivecarehotline.com?

I know this is an enormous amount of information to absorb, Patty, while you are also dealing with the emotional weight of having your husband seriously ill in ICU. This is exactly the situation where having an experienced ICU expert in your corner will make all the difference.

Here’s what my team and I can do for you:

• Review all your husband’s medical records with you in plain language
• Join a consulting call with you and the ICU and oncology team to ask the clinical questions and advocate for your husband
• Help you understand whether all appropriate tests, including molecular profiling, have been done
• Clarify the treatment plan and whether all options have been considered
• Help you plan ahead for long-term care, including home ventilation if needed
• Support you every step of the way as a family advocate

The Bottom Line, Patty, Is This:

You need to know that your husband is being correctly diagnosed and treated. That means:

1. A confirmed tissue biopsy with histological subtyping has been done
2. Comprehensive molecular and genomic profiling and PD-L1 testing has been completed
3. All metastatic sites—brain, bone, liver—have been imaged and assessed
4. The cervical pathological fracture has been reviewed by neurosurgery and or spine surgery
5. The pericarditis and pericardial effusion are being actively monitored by cardiology
6. A full multidisciplinary team including oncology, radiation oncology, neurosurgery, cardiology, and palliative care is involved
7. Treatment has been selected based on the molecular profile of the tumor
8. Your husband’s goal of care and your family’s wishes have been part of the conversation

If you’re not sure that all of this is happening or if you feel like you’re not getting clear answers, this is exactly when you need to call me.

Thank you so much for trusting me with your question, Patty. I truly hope this helps you advocate for your husband and get him the best, the very best care and treatment if possible.

I have worked in critical care nursing for 25 years in three different countries where I worked as a nurse manager for over five years in intensive care. And I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. And I can very confidently say that we have saved many lives with our consulting and advocacy, because of our insights, and you can verify that on our testimonial section  at intensivecarehotline.com and you can verify it on our intensivecarehotline.com podcast section, where we have done client interviews.  And because our advice is absolutely life-changing, right?

The biggest challenge for families in intensive care is simply that they don’t know what they don’t know. They don’t know what to look for, they don’t know what questions to ask, they don’t know their rights, and they don’t know how to manage doctors and nurses in intensive care. And that’s why we help you to improve your life instantly, making sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets the best care and treatment always. And that’s why you can join a growing number of members and clients that we have helped over the years, saving their loved ones’ lives.

And that’s why I do one-on-one consulting and advocacy over the phone, Zoom, WhatsApp, whichever medium works best for you. And I talk to you and your families directly. I handhold you through this once-in-a-lifetime situation that you simply cannot afford to get wrong. And when I talk to families directly, I also talk to doctors and nurses directly, asking all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care.  I also represent you in family meetings with intensive care teams.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also do medical record reviews after intensive care, so, if, in case you have unanswered questions, if you need closure or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care, and you can become a member if you go to intensivecarehotline.com. If you click on the membership link or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team 24 hours a day in the membership area and via email, and we answer all questions intensive care-related. In the membership, you also have exclusive access to 21 e-books and 21 videos that I’ve personally written and recorded. And all of that will help you to improve your life instantly, make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets the best care and treatment always.

And all of that you get at intensivecarehotline.com. Call us on one of the numbers at the top of our website or simply send us an email to support at intensivecarehotline.com with your questions.

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Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com, and I will talk to you in a few days.

Take care for now.