Episodic breathlessness in patients with cancer: definition, terminology, clinical features – integrative systematic review

Abstract

PurposeBreatlessness flares directly impair quality of life of patients with cancer. The aim of this review was to analyse and synthesise the available information related to its terminology, definition and clinical features in patients with cancer.MethodsIntegrative systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Literature search was conducted in MEDLINE PubMed, CINAHLPlus, Web of Science, Cochrane Central Register Controlled Trials CENTRAL, Scopus and OpenAire.ResultsData from 1065 patients with cancer included in 12 studies were analysed. The preferred term for breathlessness flares was episodic dyspnoea (ED). The reported frequency of ED was 20.4% (70.9% in patients reporting background dyspnoea (BD)). ED intensity was moderate to severe with short duration (<10 min) in >80% of patients. The most common trigger was exertion (>90%) followed by emotional or environmental factors. ED management consisted mainly of pharmacological and non-pharmacological measures.ConclusionsThis systematic review shows that ED is common in patients with cancer, especially in those with BD. Further studies are urgently needed to better understand this condition and to develop specific therapeutic management.PROSPERO registration numberCRD42019126708.

Consensus document on palliative care in cardiorenal patients

“…Evidence of absence or minimal neurotoxicity with these doses in scenarios like withdrawing dialysis suggests the potential benefit and absence of harm for these populations. However, there is still limited data ( 90 – 92 ). For opioids such as oxycodone, hydromorphone is still higher.…”