Treatment of dyspnea in cancer patients.
Dyspnea is defined as a sensation of difficult or uncomfortable breathing. The symptom is highly prevalent among cancer patients with and without direct lung involvement. The gold standard of assessment is based on patient self-report. Objective measures such as respiratory rate, oxygen saturation, and arterial blood gas measurements frequently do not correlate with the subjective experience of dyspnea. Consistent with patient goals and the disease context, treatment should be directed at removing the underlying cause when possible. Fast, safe, and effective symptomatic relief of dyspnea is possible whether or not identifiable reversible causes exist. In fact, relieving symptoms can be considered in conjunction with treating specific reversible causes. Opioids are the first-line therapy for relief of dyspnea symptoms. When prescribed appropriately, respiratory depression is not a significant concern. In the rare cases in which opioids are unable to control dyspnea, sedation is an effective, ethical, and legal option.
Thomas
Jay R
JR
Center for Palliative Studies, San Diego Hospice and School of Medicine, University of California at San Diego, USA. jthomas@sdhospice.org
Von Gunten
Charles F
CF
D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy / Q000379:methods; D004417:Dyspnea / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D009294:Narcotics / Q000627:therapeutic use; D009369:Neoplasms / Q000150:complications*; D010100:Oxygen / Q000627:therapeutic use; D012720:Severity of Illness Index; D013727:Terminal Care / Q000379:methods; D016896:Treatment Outcome
D014151:Anti-Anxiety Agents; D009294:Narcotics; D010100:Oxygen