title: Who experiences higher and increasing breathlessness in advanced cancer? The longitudinal EPCCS Study.
abstract: Breathlessness is a major cause of suffering in advanced cancer. We aimed to determine the symptom trajectory in people with advanced cancer and to identify those at increased risk of experiencing higher or increasing breathlessness over time in advanced cancer.
  
  
  
  This was an analysis of the multinational, prospective, longitudinal European Palliative Care Cancer Symptom (EPCCS) study. We included adults with confirmed incurable cancer enrolled in palliative care, with prospective monthly assessments for up to 6 months, withdrawal or death, whichever came first. Symptom severity (0-10 numerical rating scales) was analyzed using multivariate random coefficients regression.
  
  
  
  A total of 1689 patients (50 % women; mean age 65.7 ± [standard deviation; SD] 12.4 years) were included. Main diagnoses were digestive (31 %), lung (20 %), and breast (17 %) cancers. During a median follow-up of 62 (interquartile range, 0 to 133) days, 65 % were breathless at some point and 36 % of all patients reported moderate/severe breathlessness. The group mean (1.6 points; SD, 2.4) was unchanged over time, but the severity varied markedly between patients and over time. Independent predictors for worse breathlessness were COPD, lung cancer, living alone, lung metastases, anxiety, pain, depression, and lower performance status. Predictors of worsening breathlessness over time were low performance status (p = 0.039) and moderate to severe pain (p = 0.012).
  
  
  
  In the largest longitudinal clinical study to date in advanced cancer alone, breathlessness was frequent and associated with factors including respiratory disease, other concurrent unpleasant symptoms, and impaired performance status. Increase in severity over time was predicted by performance status and pain.
authors.affiliation: Discipline Palliative and Supportive Services, Flinders University, Daws Road, Adelaide, SA, 5001, Australia. pmekstrom@gmail.com.|Department of Clinical Sciences, Division of Respiratory Medicine & Allergology, Lund University, SE-221 00, Lund, Sweden. pmekstrom@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Ekström
authors.affiliation: Hull York Medical School, University of Hull, Hull, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Johnson
authors.affiliation: Section of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Schiöler
authors.affiliation: European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU) and St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.|Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
authors.forename: S
authors.initials: S
authors.lastname: Kaasa
authors.affiliation: European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU) and St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.|Regional Centre for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital, Ullevål, Oslo, Norway.|European Palliative Care Research Centre, Dept. of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
authors.forename: M J
authors.initials: MJ
authors.lastname: Hjermstad
authors.affiliation: Discipline Palliative and Supportive Services, Flinders University, Daws Road, Adelaide, SA, 5001, Australia.
authors.forename: D C
authors.initials: DC
authors.lastname: Currow
mesh_terms: D000368:Aged; D004417:Dyspnea / Q000209:etiology*; D005260:Female; D006801:Humans; D038622:Internationality; D008137:Longitudinal Studies; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology; D011446:Prospective Studies; D012307:Risk Factors
keywords: Breathlessness; COPD; Cancer; Pain; Palliative care; Predictor