Non-pharmacological interventions for breathlessness in people with cancer

Booth, Sara; Chin, Chloe; Spathis, Anna; Maddocks, Matthew; Yorke, Janelle; Burkin, Julie; Moffat, Catherine; Farquhar, Morag; Bausewein, Claudia

doi:10.1080/23809000.2018.1524708

Cited by 8 publications

(8 citation statements)

References 124 publications

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“…The current results are in line with previous findings from qualitative studies which demonstrated that the unpredictability of dyspnea is particularly frightening for patients with cardiopulmonary diseases or cancer and amplifies their perception of dyspnea (Booth et al, 2018; Lovell et al, 2018; Linde et al, 2018). These findings also converge with previous notions that the perception of dyspnea is a subjective interpretation process of respiratory input that is strongly modulated by multiple factors (von Leupoldt and Dahme, 2007; Lansing et al, 2009; Janssens et al, 2011; Hayen et al, 2013; Herigstad et al, 2017; Spathis et al, 2017; Van den Bergh et al, 2017; von Leupoldt, 2017; Similowski, 2018).…”

Section: Discussionsupporting

confidence: 92%

“…Dyspnea can be classified into predictable and unpredictable dyspnea episodes (Simon et al, 2014). Especially unpredictable dyspnea episodes have been suggested to create a strong sense of loss of control, to be specifically anxiety provoking and to amplify the perception of dyspnea (Booth et al, 2018; Lovell et al, 2018). For example, in a qualitative study patients with COPD and lung cancer reported that unpredictable dyspnea episodes were stronger and more unpleasant compared to predictable dyspnea episodes (Linde et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

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The Impact of Unpredictability on Dyspnea Perception, Anxiety and Interoceptive Error Processing

et al. 2019

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Dyspnea is a prevalent interoceptive sensation and the aversive cardinal symptom in many cardiorespiratory diseases as well as in mental disorders. Especially the unpredictability of the occurrence of dyspnea episodes has been suggested to be highly anxiety provoking for affected patients. Moreover, previous studies demonstrated that unpredictable exteroceptive stimuli increased self-reports and electrophysiological responses of anxiety such as the startle probe N100 as well as amplified the processing of errors as reflected by greater error-related negativity (ERN). However, studies directly examining the role of unpredictability on dyspnea perception, anxiety, and error processing are widely absent. Using high-density electroencephalography, the present study investigated whether unpredictable compared to predictable dyspnea would increase the perception of dyspnea, anxiety and interoceptive error processing. Thirty-two healthy participants performed a respiratory forced choice reaction time task to elicit an interoceptive ERN during two conditions: an unpredictable and a predictable resistive load-induced dyspnea condition. Predictability was manipulated by pairing (predictable condition) or not pairing (unpredictable condition) dyspnea with a startle tone probe. Self-reports of dyspnea and affective state as well as the startle probe N100 and interoceptive ERN were measured. The results demonstrated greater dyspnea unpleasantness in the unpredictable compared to the predictable condition. Post hoc analyses revealed that this was paralleled by greater anxiety, and greater amplitudes for the startle probe N100 and the interoceptive ERN during the unpredictable relative to the predictable condition, but only when the unpredictable condition was experienced in the first experimental block. Furthermore, higher trait-like anxiety sensitivity was associated with higher ratings for dyspnea unpleasantness and experimental state anxiety ratings. The present findings suggest that unpredictability increases the perception of dyspnea unpleasantness. This effect seems related to increased state and trait anxiety and interoceptive error processing, especially when upcoming dyspnea is particularly unpredictable, such as in early experimental phases. Future studies are required to further substantiate these findings in patients suffering from dyspnea.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

The Impact of Unpredictability on Dyspnea Perception, Anxiety and Interoceptive Error Processing

et al. 2019

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“…The reference electrode was placed at the left mastoid. After cleaning the skin with peeling cream to reduce the interelectrode resistance, electrodes were placed on the left side of the face according to the site specifications proposed by Blumenthal et al (2005). The raw signal was amplified by an isolated bioamplifier with a bandpass filter (13-500 Hz; v75-04; Coulbourn, Whitehall, USA) and routed to a contourfollowing integrator (20 ms; S76-01; Coulbourn, Whitehall, USA) that rectified and smoothed the signal.…”

Section: Electromyographic Startle Eyeblink Responsementioning

confidence: 99%

“…Recently, it has been emphasized that dyspnea can be categorized into predictable and unpredictable dyspnea episodes (Simon et al., 2013, 2014). In this regard, particularly unpredictable dyspnea episodes have been reported to elicit strong feelings of loss of control, to be particularly fear‐provoking and to increase the experience of dyspnea (Booth et al., 2018; Linde et al., 2018; Lovell et al., 2018). For example, in a qualitative study by Linde et al., (2018), patients with COPD and lung cancer described unpredictable dyspnea episodes as more intense and aversive when compared to predictable dyspnea episodes.…”

Section: Introductionmentioning

confidence: 99%

The impact of unpredictability of dyspnea offset on dyspnea perception, fear, and respiratory neural gating

et al. 2021

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Dyspnea is a debilitating and threatening symptom in various diseases. Affected patients often report the unpredictability of dyspnea episodes being particularly anxiety-provoking and amplifying the perception of dyspnea. Experimental studies testing dyspnea unpredictability together with related neural processes, physiological fear responses, and dyspnea-related personality traits are sparse. Therefore, we investigated the impact of unpredictability of dyspnea offset on dyspnea perception and fear ratings, respiratory neural gating and physiological fear indices, as well as the influence of interindividual differences in fear of suffocation (FoS). Forty healthy participants underwent a task manipulating the offset predictability of resistive load-induced dyspnea including one unloaded safety condition. Respiratory variables, self-reports of dyspnea intensity, dyspnea unpleasantness, and fear were recorded. Moreover, respiratory neural gating was measured in a paired inspiratory occlusion paradigm using electroencephalography, while electrodermal activity, startle eyeblink, and startle probe N100 were assessed as physiological fear indices.Participants reported higher dyspnea unpleasantness and fear when dyspnea offset was unpredictable compared to being predictable. Individuals with high levels of FoS showed the greatest increase in fear and overall higher levels of fear and physiological arousal across all conditions. Respiratory neural gating, startle eyeblink, and startle probe N100 showed general reductions during dyspnea conditions but no difference between unpredictable and predictable dyspnea conditions. Together, the current results suggest that the unpredictable offset of dyspnea amplifies dyspnea perception and fear, especially in individuals with high levels of FoS. These effects were unrelated to respiratory neural gating or physiological fear responses, requiring future studies on underlying mechanisms.

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“…Ultimately, good person-centred care is likely to reduce costs of money and time and improve clinical outcomes [16, 17]. This review does not consider care of the dying, nor improving quality of life in patients with cancer, both of which are well reviewed in standard texts [18, 19] and recent papers [20].…”

Section: Introductionmentioning

confidence: 99%

Improving the quality of life of people with advanced respiratory disease and severe breathlessness

Booth

Johnson

2019

Breathe

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Advanced respiratory disease imposes a greater symptom burden than many cancers but not does have comparable recognition of the need for supportive and palliative care or the infrastructure for its systematic delivery. Consequently, many people with advanced respiratory disease (and those closest to them) have a poor quality of life, disabled by chronic breathlessness, fatigue and other symptoms. They are socially isolated by the consequences of long-term illness and are often financially impoverished. The past decade has seen an increasing realisation that care for this group must improve and that symptom management must be prioritised. Clinical guidelines recommend person-centred care, including access to supportive and palliative care as needed, as part of standard medical practice. Advanced lung disease clinics and specialist breathlessness services (pioneered within palliative care) are developing within respiratory medicine services but are provided inconsistently.This review covers the comprehensive assessment of the patient with advanced respiratory disease, the importance of supporting carers and the current best practice in the management of breathlessness, fatigue and cough. It also suggests ways to incorporate person-centred care into the general respiratory clinic, assisted by better liaison with specialist palliative and primary care. Emerging evidence shows that excellent symptom management leads to better clinical outcomes and reduces inappropriate use of emergency medical services.Key pointsPeople living with advanced respiratory disease and severe chronic breathlessness (and those closest to them) have a poor quality of life.Chronic breathlessness is a disabling symptom, and acute-on-chronic/episodic breathlessness is frightening to experience and observe.Chronic breathlessness imposes profound physical limitations and psychosocial burdens on those suffering from it or living with someone experiencing it.Fatigue and cough are two other cardinal symptoms of advanced respiratory disease, with very detrimental effects on quality of life.The impact of all these symptoms can be alleviated to a variable extent by a predominantly non-drug complex intervention.Many of the interventions are delivered primarily by allied health or nursing professionals.Doctors, nurses and other health professionals also need to play an active part in promoting quality of life as part of excellent medical care.A person-centred, psychologically informed approach is needed by all clinicians treating patients with advanced respiratory disease.Educational aimsTo give specialist respiratory clinicians practical clinical tools to help improve the quality of life of their patients with advanced respiratory disease and chronic breathlessness.To outline the evidence base for these interventions with reference to definitive sources.To highlight the importance of person-centred care in people with respiratory disease at all stages of illness.

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Non-pharmacological interventions for breathlessness in people with cancer

Cited by 8 publications

References 124 publications

The Impact of Unpredictability on Dyspnea Perception, Anxiety and Interoceptive Error Processing

The Impact of Unpredictability on Dyspnea Perception, Anxiety and Interoceptive Error Processing

The impact of unpredictability of dyspnea offset on dyspnea perception, fear, and respiratory neural gating

Improving the quality of life of people with advanced respiratory disease and severe breathlessness

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