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
...reatment...
...ening and Assessment...
...ould perform systematic assessment of dyspn...
...o are unable to self-report, clinicians s...
...ssible, patients with dyspnea should undergo a...
...Treatment of Underlying Causes...
...ients with potentially reversible, common e...
...spnea due to underlying malignancy (e.g....
...nderlying co-morbidities such as COPD or hear...
...Referral to Palliative Care...
...ients with advanced cancer and dyspnea should be r...
...-pharmacologic Interventi...
...erventions such as directing a fan at the chee...
...d supplemental oxygen should be available for p...
...oxygen is not recommended when SpO2 >90%. (EB, I...
...d therapeutic trial of high flow nasal can...
...-limited therapeutic trial of non-invasive vent...
...pharmacologic measures such as breathing...
Acupressure/reflexology, if available, may b...
...s insufficient for a recommendation...
...harmacologic Interventi...
...pioids should be offered to patients wit...
...ng benzodiazepines may be offered to patients wh...
...ticosteroids may be offered to select patients w...
...lators should be used for palliatio...
...insufficient for a recommendation f...
...iative sedation should be offered to...
...tionsHaving trouble viewing table? E...
...pplemental Oxygen UseHaving trouble viewing ta...
...ient Management of Chronic Dyspnea...
...igure 2. Inpatient Management of Acute Sev...
...atient Management of Patients with Dyspnea i...