Breathlessness in cancer patients - implications, management and challenges.
OBJECTIVE
Breathlessness in patients with advanced cancer is common. It remains a difficult symptom to improve despite recent advances in cancer treatment and the increasing evidence available. Patients and carers experience a high level of distress from this frightening symptom. There is a greater volume of evidence to guide the management of breathlessness accompanying advanced non-malignant disease, as opposed to malignant disease, as most research has been conducted in this group. This article reviews the management of breathlessness in patients with cancer.


METHODS
A systematic review of the literature in this area was completed. The results of the research work carried out by co-authors were also reviewed. The following databases were searched: MEDLINE, CINAHL, EMBASE, PsycINFO, the Cochrane Library. This search strategy was supplemented by hand-searching references in relevant palliative care text books and by searching relevant websites.


RESULTS
Pharmacological and non-pharmacological measures to alleviate breathlessness are discussed in this paper. Non-pharmacological approaches are discussed in detail as these are currently the most effective for the greatest number of patients.


CONCLUSIONS
The cause of breathlessness in advanced cancer patients is usually multifactorial. A combination of pharmacological with non-pharmacological approaches is essential to manage breathlessness. Breathlessness services (e.g. Breathlessness Intervention Service) can be considered to be innovative and effective models of care when provided as part of a network of services aimed at helping patients with advanced cardiorespiratory disease, including patients with advanced cancer.
Addenbrookes Hospital, Palliative Care Team, Cambridge CB2 2QQ, UK. shirleythomas30@yahoo.co.uk
Shirley
S
Thomas
Claudia
C
Bausewein
Irene
I
Higginson
Sara
S
Booth
D004417:Dyspnea / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D006801:Humans; D015201:Meta-Analysis as Topic; D009369:Neoplasms / Q000150:complications* / Q000473:pathology; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome