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
...Treatment...
...1. Screeni...
...ld perform systematic assessment of...
...o are unable to self-report, clinicians should us...
Whenever possible, patients with dyspnea...
...2....
...potentially reversible, common etio...
...yspnea due to underlying malignancy (e.g., lympha...
...h underlying co-morbidities such as COPD or he...
...3. Re...
...vanced cancer and dyspnea should be referred to an...
...4. Non-pharmaco...
...rflow interventions such as directing a...
...dard supplemental oxygen should be available for p...
Supplemental oxygen is not recommended w...
...time-limited therapeutic trial of high flow nasal...
...limited therapeutic trial of non-in...
...cologic measures such as breathing techniques, po...
...e/reflexology, if available, may be offe...
...vidence remains insufficient for a recommen...
...5. Pha...
...should be offered to patients with dyspn...
...benzodiazepines may be offered to patients who...
Systemic corticosteroids may be off...
...ilators should be used for palliation of dyspn...
...remains insufficient for a recommendation for or...
...lliative sedation should be offered...
...finitionsHaving trouble viewing table? E...
.... Supplemental Oxygen UseHaving trouble...
...igure 1. Outpatient Management of Chronic...
...ent Management of Acute Severe Dyspnea...
...patient Management of Patients with Dys...