Management of Dyspnea in Advanced Cancer
Key Points
Key Points
- Dyspnea is one of the most common and distressing symptoms affecting patients with advanced cancer.
- In a meta-analysis that included over 10,000 patients with advanced cancer, 10%–70% of patients reported dyspnea.a
- The burden of dyspnea is further compounded by other related symptoms such as fatigue, anxiety, and depression, resulting in functional limitation, compromised quality of life, and increased informal (family) caregiver burden.
- In the advanced cancer setting, the presence of dyspnea, particularly at rest, indicates a poor prognosis (typically less than a few months) and has important clinical implications.
- First, a patient’s prognosis could significantly impact recommendations regarding assessments and treatments.
- Second, clinicians need to routinely engage in serious illness conversations with the patients and their caregivers to ensure prognostic understanding, discuss how dyspnea should be managed (e.g., cancer treatments, palliative options), and support advance care planning.
Treatment
...Trea...
...1. Screening and Asses...
Clinicians should perform systematic assessmen...
...o are unable to self-report, clinicians s...
...henever possible, patients with dyspnea should und...
...2. Treatment...
...atients with potentially reversible, co...
...ients with dyspnea due to underlying malignancy...
...ents with underlying co-morbidities...
...3. Referral...
...with advanced cancer and dyspnea should be r...
Airflow interventions such as direct...
...tandard supplemental oxygen should...
...upplemental oxygen is not recommended when SpO2 >9...
...me-limited therapeutic trial of high f...
...d therapeutic trial of non-invasive ventilat...
...pharmacologic measures such as breathing...
...essure/reflexology, if available, may be...
...s insufficient for a recommendation for o...
...5. Pharmacologic Interven...
...s should be offered to patients wi...
...enzodiazepines may be offered to patients who...
...ic corticosteroids may be offered to selec...
...lators should be used for palliation of dyspnea...
...nce remains insufficient for a recommendation...
...ntinuous palliative sedation should be offered...
...e 1. Definitions Term Definition...
...able 2. Supplemental Oxygen Use Dyspnea...
...utpatient Management of Chronic Dyspnea...
...ent Management of Acute Severe Dyspnea...
...e 3. Inpatient Management of Patients...