Sebastiano Mercadante1, Federica Aielli2, Claudio Adile3, Alessandro Valle4, Flavio Fusco5, Patrizia Ferrera3, Amanda Caruselli6, Claudio Cartoni7, Paolo Marchetti8, Giuseppe Bellavia6, Andrea Cortegiani9, Francesco Masedu10, Marco Valenti10, Giampiero Porzio2. 1. Pain Relief and Supportive Care Unit, La Maddalena Cancer Center, Palermo, Italy. Electronic address: terapiadeldolore@lamaddalenanet.it. 2. Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy; "L'Aquila per la Vita" Home Care Unit, L'Aquila, Italy. 3. Pain Relief and Supportive Care Unit, La Maddalena Cancer Center, Palermo, Italy. 4. Hospice and Home Care Program, FARO Foundation, Turin, Italy. 5. Home Care Program, ASP 6, Genoa, Italy. 6. Home Care Program, SAMO, Palermo, Italy. 7. Division of Hematology, Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I, Home Care Service of the Rome Section of the Italian Association Against Leukemias (Rome AIL), Rome, Italy. 8. Clinical and Molecular Medicine Department, Sapienza University, Sant'Andrea Hospital, Rome, Italy. 9. Section of Anesthesia, Analgesia, Intensive Care and Emergency, Department of Biopathology, Medical and Forensic Biotechnologies, Policlinico "P. Giaccone", University of Palermo, Palermo, Italy. 10. Section of Clinical Epidemiology and Environmental Medicine, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
Abstract
CONTEXT: Episodic breathlessness is a relevant aspect in patients with advanced cancer. OBJECTIVES: The aim of this study was to assess the different aspects of this clinical phenomenon. METHODS: A consecutive sample of patients with advanced cancer admitted to different settings for a period of six months was surveyed. The presence of background breathlessness and episodic breathlessness, their intensity (numerical scale 0-10), and drugs used for treatment were collected. Factors inducing episodic breathlessness and its influence on daily activities were investigated. RESULTS: Of 921 patients, 29.3% (n = 269) had breathlessness and 134 patients (49.8%) were receiving drugs for background breathlessness. In the multivariate analysis, the risk of breathlessness increased with chronic obstructive pulmonary disease, although it decreased in patients receiving disease-oriented therapy and patients with gastrointestinal tumors. The prevalence of episodic breathlessness was 70.9% (n = 188), and its mean intensity was 7.1 (SD 1.6). The mean duration of untreated episodic breathlessness was 19.9 minutes (SD 35.3); 41% of these patients were receiving drugs for episodic breathlessness. The majority of episodic breathlessness events (88.2%) were triggered by activity. In the multivariate analysis, higher Karnofsky Performance Status levels were significantly related to episodic breathlessness, although patients receiving disease-oriented therapy were less likely to have episodic breathlessness. CONCLUSION: This study showed that episodic breathlessness frequently occurs in patients with breathlessness in the advanced stage of disease, has a severe intensity, and is characterized by rapid onset and short duration, which require rapid measures.
CONTEXT: Episodic breathlessness is a relevant aspect in patients with advanced cancer. OBJECTIVES: The aim of this study was to assess the different aspects of this clinical phenomenon. METHODS: A consecutive sample of patients with advanced cancer admitted to different settings for a period of six months was surveyed. The presence of background breathlessness and episodic breathlessness, their intensity (numerical scale 0-10), and drugs used for treatment were collected. Factors inducing episodic breathlessness and its influence on daily activities were investigated. RESULTS: Of 921 patients, 29.3% (n = 269) had breathlessness and 134 patients (49.8%) were receiving drugs for background breathlessness. In the multivariate analysis, the risk of breathlessness increased with chronic obstructive pulmonary disease, although it decreased in patients receiving disease-oriented therapy and patients with gastrointestinal tumors. The prevalence of episodic breathlessness was 70.9% (n = 188), and its mean intensity was 7.1 (SD 1.6). The mean duration of untreated episodic breathlessness was 19.9 minutes (SD 35.3); 41% of these patients were receiving drugs for episodic breathlessness. The majority of episodic breathlessness events (88.2%) were triggered by activity. In the multivariate analysis, higher Karnofsky Performance Status levels were significantly related to episodic breathlessness, although patients receiving disease-oriented therapy were less likely to have episodic breathlessness. CONCLUSION: This study showed that episodic breathlessness frequently occurs in patients with breathlessness in the advanced stage of disease, has a severe intensity, and is characterized by rapid onset and short duration, which require rapid measures.
Authors: Kathleen M Akgün; Supriya Krishnan; Shelli L Feder; Janet Tate; Jean S Kutner; Kristina Crothers Journal: Am J Hosp Palliat Care Date: 2019-09-24 Impact factor: 2.500