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
Treatme...
.... Screening and Assessmen...
...ns should perform systematic assessment of dyspnea...
For patients who are unable to self-re...
...ver possible, patients with dyspnea sho...
...ent of Underlying Causes...
...nts with potentially reversible, common etiologie...
...s with dyspnea due to underlying malignancy (e....
...nts with underlying co-morbidities...
...erral to Palliative Care...
...with advanced cancer and dyspnea should be...
.... Non-pharmacologic Interventi...
...flow interventions such as directing a fan...
...lemental oxygen should be available f...
...emental oxygen is not recommended...
...-limited therapeutic trial of high fl...
...time-limited therapeutic trial of no...
...on-pharmacologic measures such as breathing t...
...eflexology, if available, may be offered. (EB, L,...
Evidence remains insufficient for...
...ologic Interventions
...mic opioids should be offered to p...
...t-acting benzodiazepines may be offered to patie...
...corticosteroids may be offered to select...
...ators should be used for palliation o...
...insufficient for a recommendation for or against...
...alliative sedation should be offered t...
...initionsHaving trouble viewing table? Expand...
...2. Supplemental Oxygen UseHaving trouble viewing...
...ient Management of Chronic Dyspnea...
...e 2. Inpatient Management of Acute Severe Dyspnea...
...Inpatient Management of Patients with Dy...