Management of Dyspnea in Advanced Cancer

Publication Date: February 1, 2021

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

Treatm...

...creening and Assessme...

...ians should perform systematic assessment o...

...ho are unable to self-report, clinicians should...

...er possible, patients with dyspnea should und...


...tment of Underlying Causes...

...th potentially reversible, common etiologies o...

...dyspnea due to underlying malignancy (e.g., lymp...

...ts with underlying co-morbidities such as COPD or...


...l to Palliative Care...

...dvanced cancer and dyspnea should be referred to a...


...n-pharmacologic Interven...

...tions such as directing a fan at the cheek (t...

...lemental oxygen should be available for pa...

...gen is not recommended when SpO2 >90%. (E...

...e-limited therapeutic trial of high flow nasal...

...ited therapeutic trial of non-invasive ventil...

...non-pharmacologic measures such as breat...

Acupressure/reflexology, if availabl...

...ns insufficient for a recommendation for or aga...


...Pharmacologic Interventi...

...opioids should be offered to patients with dyspnea...

...cting benzodiazepines may be offer...

...steroids may be offered to select patients with...

...s should be used for palliation of d...

...remains insufficient for a recomme...

...s palliative sedation should be offered to patient...


...le 1. DefinitionsHaving trouble viewin...


...2. Supplemental Oxygen UseHaving troub...


...atient Management of Chronic Dyspnea...


...ure 2. Inpatient Management of Acut...


...npatient Management of Patients with D...