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
...eatment...
...creening and Assessment...
...nicians should perform systematic assessment...
...ients who are unable to self-report, clinicians...
...possible, patients with dyspnea should u...
...reatment of Underlying Cau...
...potentially reversible, common etiologies...
...spnea due to underlying malignancy (e.g....
...nts with underlying co-morbidities such as COPD...
...eferral to Palliative Care
...ts with advanced cancer and dyspnea should...
...-pharmacologic Interventions...
...tions such as directing a fan at the cheek (tr...
...ental oxygen should be available for patients w...
...oxygen is not recommended when SpO2 >90%. (E...
A time-limited therapeutic trial of high flow nas...
...mited therapeutic trial of non-invasive ventila...
Other non-pharmacologic measures such as breat...
...sure/reflexology, if available, may be offere...
...vidence remains insufficient for a recommendati...
...Pharmacologic Intervention...
...ids should be offered to patients with dyspne...
...g benzodiazepines may be offered to...
Systemic corticosteroids may be offered to sele...
...dilators should be used for palliation of dys...
...insufficient for a recommendation f...
...liative sedation should be offered to patien...
...le 1. DefinitionsHaving trouble viewing...
...Supplemental Oxygen UseHaving trouble viewi...
...1. Outpatient Management of Chronic Dyspnea...
...ent Management of Acute Severe Dys...
.... Inpatient Management of Patients wit...