Breathlessness in cancer patients - implications, management and challenges

Abstract

Purpose of the review: 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.

Key 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.