Dyspnea in cancer patients. Etiology, resource utilization, and survival-implications in a managed care world.
BACKGROUND
Dyspnea is the fourth most common symptom of patients who present to the emergency department (ED) at The University of Texas M. D. Anderson Cancer Center and may, in some patients with advanced cancer, represent a clinical marker for the terminal phase of their disease. This retrospective study describes the clinical characteristics of these patients, the resource utilization associated with the management of dyspnea, and the survival of patients with this symptom.


METHODS
The authors randomly selected 122 of 1068 patients presenting with dyspnea for a retrospective analysis. The median age of the patients was 58 years (range, 23-90 years) and 53% were female. Underlying malignancies were breast cancer (30%), lung cancer (37%), and other cancers (34%). Approximately 94% of the patients had received prior cancer treatment and the majority (69%) had uncontrolled, progressive disease.


RESULTS
The most common treatments administered in the ED were oxygen (31%), beta-2 agonists (14%), antibiotics (12%), and narcotics (11%). Approximately 60% of patients were admitted to the hospital from the ED for further treatment of dyspnea and the underlying malignancy, and the median length of stay was 9 days. The median overall survival after the ED visit for dyspnea was 12 weeks. Specific diagnoses were associated with different median survival rates: lung cancer patients: 4 weeks; breast cancer patients: 22 weeks (P = 0.0073, vs. lung cancer); and other cancer diagnoses: 27 weeks (P = 0.0027, vs. lung cancer).


CONCLUSIONS
Lung cancer patients presenting to the ED with dyspnea have much shorter survival than patients with other malignancies. For some patients, the presence of dyspnea requiring emergency treatment may indicate a phase in their illness in which resources should be shifted from acute intervention with hospitalization to palliative and supportive care measures.
Escalante
C P
CP
Department of Medical Specialties, University of Texas M. D. Anderson Cancer Center, Houston 77030-4095, USA.
Martin
C G
CG
Elting
L S
LS
Cantor
S B
SB
Harle
T S
TS
Price
K J
KJ
Kish
S K
SK
Manzullo
E F
EF
Rubenstein
E B
EB
D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000150:complications / Q000628:therapy; D018450:Disease Progression; D004417:Dyspnea / Q000209:etiology* / Q000628:therapy; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000150:complications / Q000628:therapy; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use; D009369:Neoplasms / Q000150:complications* / Q000628:therapy; D010102:Oxygen Inhalation Therapy; D010166:Palliative Care; D012189:Retrospective Studies; D015996:Survival Rate; D019452:Terminally Ill
D000318:Adrenergic beta-Agonists; D000900:Anti-Bacterial Agents; D009294:Narcotics