Dyspnea in Hospitalized Advanced Cancer Patients: Subjective and Physiologic Correlates

Abstract

Background and objective: It is unclear if physiologic measures are useful for assessing dyspnea. We examined the association among the subjective rating of dyspnea according to patients with advanced cancer, caregivers and nurses, and various physiologic measures. Methods: We conducted a cross-sectional survey of patients with cancer hospitalized at MD Anderson Cancer Center. We asked patients, caregivers, and nurses to assess the patients' dyspnea at the time of study enrollment independently using a numeric rating scale (0 = none, 10 = worst). Edmonton Symptom Assessment Scale (ESAS) ratings, causes of dyspnea, vitals, and Respiratory Distress Observation Scale [RDOS] ratings were collected. Results: A total of 299 patients were enrolled in the study: average age 62 (range 20-98), female 47%, lung cancer 37%, and oxygen use 57%. The median RDOS rating was 2/16 (interquartile range 1-3) and the number of potential causes was 3 (range 2-4), with pleural effusion (n = 166, 56%), pneumonia (n = 144, 48%), and lung metastasis (n = 125, 42%) being the most common. The median intensity of patients' dyspnea at the time of assessment was 3 (interquartile range 0-6) for patients, 4 (interquartile range 1-6) for caregivers, and 2 (interquartile range 0-3) for bedside nurses. Patients' expression of dyspnea correlated moderately with caregivers' (r = 0.68, p < 0.001) and nurses' (r = 0.50, p < 0.001) assessments, and weakly with RDOS (r = 0.35, p < 0.001), oxygen level (r = 0.32, p < 0.001), and the number of potential causes (r = 0.19, p = 0.001). In multivariate analysis, patients' dyspnea was only independently associated with ESAS dyspnea ( p = 0.002) and dyspnea as assessed by caregivers ( p < 0.001). Conclusion: Patients' level of dyspnea was weakly associated with physiologic measures. Caregivers' perception may be a useful surrogate for dyspnea assessment.

Symptom Clusters in Advanced Cancer Patients: An Empirical Comparison of Statistical Methods and the Impact on Quality of Life

“…Advanced cancer patients have been shown to causally relate the symptoms of fatigue, loss of appetite and weight loss (23), yet the experience of fatigue has been proposed to have three distinct transitional stages, from tiredness to fatigue to exhaustion/weakness (24). Similarly, although dyspnoea did not consistently cluster with other symptoms in our analyses, it has been associated with anxiety in other research (25)(26)(27). Anxiety is not explicitly represented in the QLQ-C30.…”

Symptom Expression in the Last Seven Days of Life Among Cancer Patients Admitted to Acute Palliative Care Units

“…Taken together, our findings suggest that it is possible to document patient-reported outcomes even in the last days of life. This is particularly important because caregivers’ and health care professionals’ proxy assessments are often less reliable (24). …”

Prevalence of Sudden Death in Palliative Care: Data From the Australian Palliative Care Outcomes Collaboration

“…Symptom distress over the previous 24 hours was scored on a numerical rating scale (NRS) between 0 ("no distress") and 10 ("worst possible distress"). Scores were by self-report if possible or otherwise by proxy (17,18).…”