Characteristics and Correlates of Dyspnea in Patients with Advanced Cancer

Reddy, Suresh; Parsons, Henrique A.; Elsayem, Ahmed; Palmer, J. Lynn; Bruera, Éduardo

doi:10.1089/jpm.2008.0158

Cited by 127 publications

(142 citation statements)

References 40 publications

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“…Moreover, most patients with obvious causes of breathlessness were excluded. 9 In a mixed population, episodes of breathlessness were more severe and longer in patients with COPD than in those with lung cancer; in cancer patients, 90% presented with more than three episodes a day. 13 …”

Section: Prevalencementioning

confidence: 89%

“…), episodic breathlessness was recorded alone in 61% of patients, suggesting that it often occurs without background breathlessness. 9 But, a number of patients with constant breathlessness did not report episodic breathlessness. It is likely that a misinterpretation of the questionnaire may have biased the results, as confirmed by the higher intensity of constant breathlessness in comparison with episodic breathlessness.…”

Section: Prevalencementioning

confidence: 99%

“…The definition used in this study resembles previous operational definitions. 8,9 Episodic breathlessness also has been considered as incident dyspnea on a background of either irreversible dyspnea at rest or when speaking, in patients using a stable regular dose of an opioid, 10 assuming that the treatment should be reserved to opioidtolerant patients.…”

Section: Prevalencementioning

confidence: 99%

“…In previous patient-reported experiences described in the literature, the most frequent duration of episodic breathlessness was 5e15 minutes. 9,13,16,17 Of concern, a risk of recall bias cannot be excluded. In this study, which provided a clear definition of episodic breathlessness, the intensity of episodic breathlessness was higher (about 7/10) in comparison with values of breathlessness (about 4/10); this helps confirm the clear distinction in the definition of episodic breathlessness, which is different from common oscillations throughout the day, and resembles recent observations on breakthrough pain.…”

Section: Duration and Intensitymentioning

confidence: 99%

“…8 On other occasions, overlapping intensities of breathlessness and episodic breathlessness were confounding factors. 8,9 In the literature, the mean number of episodic breathlessness occurrences has been reported to be one to five per day. 12 We did not assess this number, as we expected that it was strongly dependent on the will or the need to start an activity or not, as occurs with breakthrough pain with an incident component because of movement.…”

Section: Duration and Intensitymentioning

confidence: 99%

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Epidemiology and Characteristics of Episodic Breathlessness in Advanced Cancer Patients: An Observational Study

Mercadante

Aielli

Adile

et al. 2016

Journal of Pain and Symptom Management

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CONTEXT:Episodic breathlessness is a relevant aspect in patients with advanced cancer.\ud OBJECTIVES:The aim of this study was to assess the different aspects of this clinical phenomenon.\ud METHODS:A consecutive sample of patients with advanced cancer admitted to different settings for a period of six months was surveyed. The presence of background breathlessness and episodic breathlessness, their intensity (numerical scale 0-10), and drugs used for treatment were collected. Factors inducing episodic breathlessness and its influence on daily activities were investigated.\ud RESULTS:Of 921 patients, 29.3% (n = 269) had breathlessness and 134 patients (49.8%) were receiving drugs for background breathlessness. In the multivariate analysis, the risk of breathlessness increased with chronic obstructive pulmonary disease, although it decreased in patients receiving disease-oriented therapy and patients with gastrointestinal tumors. The prevalence of episodic breathlessness was 70.9% (n = 188), and its mean intensity was 7.1 (SD 1.6). The mean duration of untreated episodic breathlessness was 19.9 minutes (SD 35.3); 41% of these patients were receiving drugs for episodic breathlessness. The majority of episodic breathlessness events (88.2%) were triggered by activity. In the multivariate analysis, higher Karnofsky Performance Status levels were significantly related to episodic breathlessness, although patients receiving disease-oriented therapy were less likely to have episodic breathlessness.\ud CONCLUSION:This study showed that episodic breathlessness frequently occurs in patients with breathlessness in the advanced stage of disease, has a severe intensity, and is characterized by rapid onset and short duration, which require rapid measures

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Section: Prevalencementioning

confidence: 89%

Section: Prevalencementioning

confidence: 99%

Section: Prevalencementioning

confidence: 99%

Section: Duration and Intensitymentioning

confidence: 99%

Section: Duration and Intensitymentioning

confidence: 99%

See 3 more Smart Citations

Epidemiology and Characteristics of Episodic Breathlessness in Advanced Cancer Patients: An Observational Study

Mercadante

Aielli

Adile

et al. 2016

Journal of Pain and Symptom Management

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Nonpharmacological Interventions for Managing Breathlessness in Patients With Advanced Cancer

et al. 2021

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IMPORTANCE Breathlessness is a frequent and debilitating symptom in patients with advanced cancer. Often, in the context of breathlessness, aggressive cancer treatment is not beneficial, feasible, or aligned with goals of care. Targeted symptom-focused interventions may be helpful in this scenario.OBJECTIVE To evaluate the advantages and harms of nonpharmacological interventions for managing breathlessness in adults with advanced cancer.EVIDENCE REVIEW PubMed, Embase, CINAHL, Web of Science, and the Cochrane Central Register of Controlled Trials were searched from inception through May 2020 for published randomized clinical trials (RCTs), nonrandomized controlled trials, and observational studies of the advantages and/or harms of nonpharmacological interventions on alleviating breathlessness in adults with advanced cancer. Only English-language studies were screened for eligibility, titles, abstracts, and full text. Risk of bias and strength of evidence (SOE) were independently assessed. The key outcomes reported in studies were breathlessness, anxiety, exercise capacity, health-related quality of life, and harms. Data were analyzed from October 1, 2019, to June 30, 2020.FINDINGS A total of 29 RCTs (2423 participants) were included. These RCTs evaluated various types of interventions, such as respiratory (9 RCTs), activity and rehabilitation (7 RCTs), behavioral and psychoeducational (3 RCTs), integrative medicine (4 RCTs), and multicomponent (6 RCTs). Several nonpharmacological interventions were associated with improved breathlessness, including fan therapy (standardized mean difference [SMD], −2.09; 95% CI, −3.81 to −0.37; I 2 = 94.3%; P for heterogeneity = .02; moderate SOE) and bilevel ventilation (estimated slope difference, −0.58; 95% CI, −0.92 to −0.23; low SOE), lasting for a few minutes to hours, in the inpatient setting. In the outpatient setting, nonpharmacological interventions associated with improved breathlessness were acupressure and reflexology (integrative medicine) (low SOE) and multicomponent interventions (combined activity and rehabilitation, behavioral and psychoeducational, and integrative medicine) (low SOE) lasting for a few weeks to months. Five of the 29 RCTs (17%) reported adverse events, although adverse events and study dropouts were uncommon.CONCLUSIONS AND RELEVANCE Findings of this review include the safety and association with improved breathlessness of several nonpharmacological interventions for adults with advanced cancer. Guidelines and clinical practice should evolve to incorporate nonpharmacological interventions as first-line treatment for adults with advanced cancer and breathlessness.

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Self management interventions for breathlessness in adult cancer patients

Howell

Bezjak

Sidani

et al. 2012

Cochrane Database of Systematic Reviews

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Characteristics and Correlates of Dyspnea in Patients with Advanced Cancer

Abstract: Dyspnea in patients with advanced cancer more frequently had breakthrough characteristics, was of very short duration, and interfered with daily activities.

Cited by 127 publications

References 40 publications

Epidemiology and Characteristics of Episodic Breathlessness in Advanced Cancer Patients: An Observational Study

Epidemiology and Characteristics of Episodic Breathlessness in Advanced Cancer Patients: An Observational Study

Nonpharmacological Interventions for Managing Breathlessness in Patients With Advanced Cancer

Self management interventions for breathlessness in adult cancer patients

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