title: Epidemiology and Characteristics of Episodic Breathlessness in Advanced Cancer Patients: An Observational Study.
abstract: BACKGROUND
  Episodic breathlessness is a relevant aspect in patients with advanced cancer.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.affiliation: Pain Relief and Supportive Care Unit, La Maddalena Cancer Center, Palermo, Italy. Electronic address: terapiadeldolore@lamaddalenanet.it.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Mercadante
authors.affiliation: 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.
authors.forename: Federica
authors.initials: F
authors.lastname: Aielli
authors.affiliation: Pain Relief and Supportive Care Unit, La Maddalena Cancer Center, Palermo, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Adile
authors.affiliation: Hospice and Home Care Program, FARO Foundation, Turin, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Valle
authors.affiliation: Home Care Program, ASP 6, Genoa, Italy.
authors.forename: Flavio
authors.initials: F
authors.lastname: Fusco
authors.affiliation: Pain Relief and Supportive Care Unit, La Maddalena Cancer Center, Palermo, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Ferrera
authors.affiliation: Home Care Program, SAMO, Palermo, Italy.
authors.forename: Amanda
authors.initials: A
authors.lastname: Caruselli
authors.affiliation: 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.
authors.forename: Claudio
authors.initials: C
authors.lastname: Cartoni
authors.affiliation: Clinical and Molecular Medicine Department, Sapienza University, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Marchetti
authors.affiliation: Home Care Program, SAMO, Palermo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bellavia
authors.affiliation: Section of Anesthesia, Analgesia, Intensive Care and Emergency, Department of Biopathology, Medical and Forensic Biotechnologies, Policlinico "P. Giaccone", University of Palermo, Palermo, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Cortegiani
authors.affiliation: Section of Clinical Epidemiology and Environmental Medicine, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Masedu
authors.affiliation: Section of Clinical Epidemiology and Environmental Medicine, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Valenti
authors.affiliation: 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.
authors.forename: Giampiero
authors.initials: G
authors.lastname: Porzio
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use; D015897:Comorbidity; D004417:Dyspnea / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000453:epidemiology* / Q000503:physiopathology* / Q000628:therapy; D010166:Palliative Care / Q000379:methods; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D013997:Time Factors
chemical_list: D002317:Cardiovascular Agents
keywords: Episodic breathlessness; advanced cancer; dyspnea; opioids; palliative care