Interventions for alleviating cancer-related dyspnea: a systematic review and meta-analysis

Management of Breathlessness in Patients With Advanced Cancer: A Narrative Review

Breathlessness is defined as "a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity." It is a common and distressing symptom reported by patients with advanced malignancy. It occurs in up to 70% of patients with advanced cancer, and the symptom is aggravated with disease progression. This article reviews the etiology, assessment, and measurement of dyspnea in patients with advanced cancer. Because of its complex biopsychological etiology and manifestations, multidisciplinary approach with combination of both pharmacological and nonpharmacological interventions provides the best treatment plan for patients with dyspnea.

End of life/palliative care/ethics

Palliative and end-of-life care, once the purview of oncologists and intensivists, has also become the responsibility of the emergency physician. As our population ages and medical technology enables increased longevity, it is essential that all medical professionals know how to help patients negotiate the balance between quantity and quality of life. Emergency physicians have the opportunity to educate patients and their loved ones on how to best accomplish their goals of care while also enhancing quality of life through treatment of symptoms. The emergency physician must be aware of the ethical and medico-legal parameters that govern decision making.

Outcome measures for palliative oxygen therapy: relevance and practical utility

Dyspnea is a common symptom in many advanced malignant and non-malignant diseases and often is refractory to the usual therapies. In such circumstances palliative care approaches are necessary and among them palliative care oxygen therapy can be applied although currently its effectiveness is rather uncertain. Palliative oxygen therapy can be given on either continuous basis or on demand. Often the continuous palliative oxygen therapy is seen as long-term oxygen therapy although their aims are rather different. Palliative oxygen therapy was evaluated in populations with mixed underlying diseases, with outcome measures not only the most appropriate for the setting and therefore these limitations might have influenced the overall perceived therapeutic benefit. Therefore an evaluation of this method in subsets defined based on the etiology and pathogenic mechanisms and with appropriate outcome measures would help to better define the criteria for its indication and would increase its acceptability.

Effects of Lewis lung carcinoma and B16 melanoma on the innervation of the mouse trachea

Cancer patients often suffer from dyspnea the pathogenesis of which is incompletely understood. Both dyspnea and pulmonary diseases are closely linked to airway innervation. Recently, it was shown that Lewis lung carcinoma induces cardiac hypoinnervation in the mouse. We hypothesized that airway innervation undergoes similar changes as myocardial innervation and that this effect occurs in different mouse models of cancer. C57Bl6 mice were randomly assigned to subcutaneous injection of Lewis lung carcinoma cells (LLC, n=6), B16 melanoma cells (B16, n=6), or saline (control group, C, n=10). After 16 or 21 days, respectively, the trachea was processed for light and electron microscopic design-based stereology and the volume, surface area and length of axons ramifying in the tracheal wall were estimated. Body weight was reduced both in LLC and B16 vs. C. Hypoinnervation was present in both tumor groups compared to controls as volume and surface area of axons were significantly reduced in LLC and B16. However, the total length of tracheal axons and the mean number of axons per nerve fiber were reduced only in LLC but not in B16 compared to C indicating a differentially pronounced effect of cancer on tracheal innervation. In conclusion, reduced innervation of the trachea was observed in two different murine tumor models. These findings add to the pathophysiological concepts explaining cancer-related dyspnea and open new perspectives of treating this symptom.

Management of respiratory symptoms in patients with advanced lung cancer

SUMMARY Respiratory symptoms requiring palliation in patients with lung cancer may be caused either by the primary tumor itself, or by locoregional metastases within the thorax. Moreover, pulmonary symptoms can also be secondary, stemming from complications of lung cancer treatment or from independent comorbid conditions. This article outlines current recommendations for palliative care in lung cancer patients sorted according to salient respiratory symptoms (dyspnea, cough and hemoptysis). Written from the pulmonological point of view, the article gives an overview of what pulmonary specialists can offer, including invasive endobronchial and surgical procedures.