Sequential occurrence of dyspnea at the end of life in palliative care, according to the underlying cancer

Abstract

Dyspnea is a symptom that severely affects the quality of life of terminally ill patients. Its frequency differs considerably between studies. We aimed to characterize the frequency of dyspnea in a palliative care hospital (PCH) and to identify factors predisposing to dyspnea, particularly during the very last days of life, as a function of the underlying disease. Episodes of dyspnea were identified by the computerized extraction of prospectively collected data from the reports of care assistants or from medical observations recorded in the medical files for all stays at our PCH during the last 6 years. There were 6455 hospital stays, 88% ending in the death of the patient; 13,282 episodes of dyspnea were recorded during 2608 hospital stays (40%). Dyspnea was more frequently observed in cases of cancer than in other conditions (RR = 1.30; 95% CI: 1.14–1.48). Pulmonary metastasis increased the risk of dyspnea from 37% to 51% (RR = 1.37; 95% CI: 1.29–1.46). Dyspnea frequency varied with the primary cancer site, from 24% (brain cancer) to 60% (esophageal cancer). The data for cancer patients staying for more than 6 days who subsequently died indicated that 8% of patients experienced dyspnea exclusively during the last 4 days of the life, independently of the site of the primary cancer. Dyspnea during the last few days of life requires systematic assessment. Exclusively terminal dyspnea should be distinguished from more precocious dyspnea, as the pathophysiological mechanisms and treatments of these two forms are probably different.

Hospice use and end‐of‐life care among older patients with esophageal cancer

“…Patients with esophageal cancer experience high rates of pain, dyspnea, and dysphagia; however, the best management of these patients at the end of life remains unclear. Notably, little research exists to describe their patterns of hospice utilization.…”

Communication with Families in the Last Days of a Patient’s Life and Optimal Delivery of a Death Pronouncement

“…Dyspnea results from several causes, including atelectasis due to tumor growth, pleural effusion, superior vena cava syndrome, pulmonary embolism, anemia, etc. [15,23,24]. The prevalence of dyspnea in the last 2 weeks of life is 56.7% [4].…”

Management of Dyspnea in Palliative Care

“…Dyspnea leads to considerable suffering for patients and caregivers, and can be a cause of treatment interruption, treatment discontinuation, emergency room attendance, and death 2,3 . Unlike other symptoms, dyspnea intensifies in severity throughout the duration of the patient's disease trajectory 4,5 . Assessing dyspnea can present the clinician with a diagnostic challenge when the selfreported distress of the patient is compared with physiologic measures obtained in a clinic visit or with findings from diagnostic imaging.…”