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Simon ST, Higginson IJ, Booth S, Harding R, Bausewein C. Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases in adults. Cochrane Database Syst Rev 2010:CD007354. [PMID: 20091630 DOI: 10.1002/14651858.cd007354.pub2] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Breathlessness is one of the most common symptoms experienced in the advanced stages of malignant and non-malignant disease. Benzodiazepines are widely used for the relief of breathlessness in advanced diseases and are regularly recommended in the literature. However, the evidence for their use for this symptom is unclear. OBJECTIVES To determine the efficacy of benzodiazepines for the relief of breathlessness in patients with advanced disease. SEARCH STRATEGY We searched 14 electronic databases up to September 2009. We checked the reference lists of all relevant studies, key textbooks, reviews, and websites. We contacted investigators and specialists in palliative care for unpublished data. SELECTION CRITERIA We included randomised controlled trials (RCTs) and controlled clinical trials (CCTs) assessing the effect of benzodiazepines in relieving breathlessness in patients with advanced stages of cancer, chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), motor neurone disease (MND), and idiopathic pulmonary fibrosis (IPF). DATA COLLECTION AND ANALYSIS Two review authors independently assessed identified titles and abstracts. Three independent review authors performed assessment of all potentially relevant studies (full text), data extraction, and assessment of methodological quality. We carried out meta-analysis where appropriate. MAIN RESULTS Seven studies were identified, including 200 analysed participants with advanced cancer and COPD. Analysis of all seven studies (including a meta-analysis of six out of seven studies) did not show a beneficial effect of benzodiazepines for the relief of breathlessness in patients with advanced cancer and COPD. Furthermore, no significant effect could be observed in the prevention of breakthrough dyspnoea in cancer patients. Sensitivity analysis demonstrated no significant differences regarding type of benzodiazepine, dose, route and frequency of delivery, duration of treatment, or type of control. AUTHORS' CONCLUSIONS There is no evidence for a beneficial effect of benzodiazepines for the relief of breathlessness in patients with advanced cancer and COPD. There is a slight but non-significant trend towards a beneficial effect but the overall effect size is small. Benzodiazepines caused more drowsiness as an adverse effect compared to placebo, but less compared to morphine. These results justify considering benzodiazepines as a second or third-line treatment within an individual therapeutic trial, when opioids and non-pharmacological measures have failed to control breathlessness. Although a few good quality studies were included in this review, there is still a further need for well-conducted and adequately powered studies.
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Affiliation(s)
- Steffen T Simon
- Institute of Palliative Care (ipac), Uferstr. 20, Oldenburg, Germany, 26135
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102
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Nikles J, Mitchell G, Walters J, Hardy J, Good P, Rowett D, Shelby-James T, Currow D. Prioritising drugs for single patient (n-of-1) trials in palliative care. Palliat Med 2009; 23:623-34. [PMID: 19605605 DOI: 10.1177/0269216309106461] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Many of the drugs prescribed commonly to palliative care patients have potentially significant side-effects and are of unproven benefit. The acquisition of evidence to support the prescribing of these drugs has been very slow. Single patient trials (SPTs) (also known as n-of-1 trials) offer a potential means of obtaining the evidence necessary to support or refute the use of several of the drugs and interventions whose use is currently based on physician experience or anecdote alone. A list of SPTs considered "most urgent", for commonly employed treatments and for the most common and most troublesome symptoms in palliative care is presented. These are drugs for which the gap between evidence and practice is greatest, where the evidence of efficacy is most lacking, where significant side effects potentially lead to the greatest morbidity, or where cost is a major patient burden. Although not all the drugs used in palliative care are suitable, SPTs provide a potential alternative method of gathering evidence in palliative care.
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Affiliation(s)
- J Nikles
- Discipline of General Practice, The University of Queensland, Herston, Brisbane, Queensland, Australia.
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103
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Reddy SK, Parsons HA, Elsayem A, Palmer JL, Bruera E. Characteristics and correlates of dyspnea in patients with advanced cancer. J Palliat Med 2009; 12:29-36. [PMID: 19284260 DOI: 10.1089/jpm.2008.0158] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Dyspnea is a very distressing symptom present in the vast majority of patients with advanced cancer. There are limited data on the characteristics and correlates of dyspnea in this population. The purpose of this study was to characterize dyspnea, explore the differences between breakthrough and continuous presentations, and to determine factors associated with its intensity. METHODS Prospective observational study among 70 patients with dyspnea referred to a palliative care service. Dyspnea was assessed using the Edmonton Symptom Assessment System (ESAS, 0-10) and the Oxygen Cost Diagram (OCD). Oximetry, pulmonary function tests, Hospital Anxiety and Depression Scale (HADS), and a detailed systematic evaluation of daily characteristics of dyspnea were performed. Other symptoms were recorded using the ESAS. RESULTS Of 30 patients, 70 (43%) were female, median age was 58 (range, 28-87), and the most frequent cancer diagnosis were lung (31/70; 44%) and urologic (15/70; 21%). Constant dyspnea occurred in 27 of 70 (39%) patients, with 14 of 70 (20%) presenting breakthrough episodes. Breakthrough-only dyspnea occurred in 43 of 70 (61%). The majority of patients with breakthrough episodes (39/57; 68%) presented fewer than 5 episodes daily, most frequently lasting for less than 10 minutes (50/57; 88%). In univariate analyses ESAS dyspnea was associated with fatigue (p < 0.0001), sleep (p = 0.002), anxiety (p = 0.006), depression (p = 0.01), sensation of well-being (p = 0.03), and with OCD (p = 0.001). In multivariate analysis, ESAS dyspnea was associated with fatigue (p = 0.001), forced expiratory volume (p = 0.004), pain (p = 0.01), and depression (p = 0.03). Dyspnea intensity significantly interfered with activities (general activity, p = 0.01, mood, p = 0.02, walking ability, p = 0.04, normal work p = 0.04, and enjoyment of life, p = 0.01). CONCLUSION Dyspnea in patients with advanced cancer more frequently had breakthrough characteristics, was of very short duration, and interfered with daily activities.
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Affiliation(s)
- Suresh K Reddy
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
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104
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Kim JH, Choi YS. The Last Hours of Living: Practical Advice for Clinicians. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2009. [DOI: 10.5124/jkma.2009.52.7.697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jung Hyun Kim
- Department of Family Medicine, Cheongju Hana General Hospital, Korea.
| | - Youn Seon Choi
- Department of Family Medicine, Korea University College of Medicine, Korea.
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105
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106
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107
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108
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Cachia E, Ahmedzai SH. Breathlessness in cancer patients. Eur J Cancer 2008; 44:1116-23. [PMID: 18424030 DOI: 10.1016/j.ejca.2008.03.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 03/11/2008] [Indexed: 12/01/2022]
Abstract
Breathlessness (or dyspnoea) is a common symptom experienced by cancer patients. It may be iatrogenic and is often caused or aggravated by co-morbidity. Recent studies have elucidated the neural and chemical controls of breathing which may be involved in the production of dyspnoea. A rational approach involves making a diagnosis of aetiology and treating reversible causes wherever possible. The main approaches for palliation of dyspnoea include anti-cancer treatments; drugs; oxygen and airflow; non-medical approaches. Further research is needed to clarify the best pharmacological regimens and the place of more invasive interventions.
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Affiliation(s)
- Elaine Cachia
- Palliative Medicine, Sheffield Teaching Hospitals Foundation NHS Trust
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109
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Cuervo Pinna MÁ, Mota Vargas R, Redondo Moralo MJ, Correas MÁS. Pharmacologic Intervention for Cancer-Related Dyspnea. J Clin Oncol 2008; 26:4225; author reply 4226. [DOI: 10.1200/jco.2008.18.3566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Rafael Mota Vargas
- Regional Palliative Care Program of Extremadura, Palliative Care Team of Badajoz, Spain
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110
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Dy SM, Lorenz KA, Naeim A, Sanati H, Walling A, Asch SM. Evidence-Based Recommendations for Cancer Fatigue, Anorexia, Depression, and Dyspnea. J Clin Oncol 2008; 26:3886-95. [DOI: 10.1200/jco.2007.15.9525] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The experience of patients with cancer often involves symptoms of fatigue, anorexia, depression, and dyspnea. Methods We developed a set of standards through an iterative process of structured literature review and development and refinement of topic areas and standards and subjected recommendations to rating by a multidisciplinary expert panel. Results For fatigue, providers should screen patients at the initial visit, for newly identified advanced cancer, and at chemotherapy visits; assess for depression and insomnia in newly identified fatigue; and follow up after treatment for fatigue or a secondary cause. For anorexia, providers should screen at the initial visit for cancer affecting the oropharynx or gastrointestinal tract or advanced cancer, evaluate for associated symptoms, treat underlying causes, provide nutritional counseling for patients undergoing treatment that may affect nutritional intake, and follow up patients given appetite stimulants. For depression, providers should screen newly diagnosed patients, those started on chemotherapy or radiotherapy, those with newly identified advanced disease, and those expressing a desire for hastened death; document a treatment plan in diagnosed patients; and follow up response after treatment. For general dyspnea, providers should evaluate for causes of new or worsening dyspnea, treat or symptomatically manage underlying causes, follow up to evaluate treatment effectiveness, and offer opioids in advanced cancer when other treatments are unsuccessful. For dyspnea and malignant pleural effusions, providers should offer thoracentesis, follow up after thoracentesis, and offer pleurodesis or a drainage procedure for patients with reaccumulation and dyspnea. Conclusion These standards provide a framework for evidence-based screening, assessment, treatment, and follow-up for cancer-associated symptoms.
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Affiliation(s)
- Sydney M. Dy
- From the Johns Hopkins University, Baltimore, MD; Veterans Affairs Greater Los Angeles Healthcare System; David Geffen School of Medicine at University of California at Los Angeles, Los Angeles; and RAND Health, Santa Monica; and University of California, Irvine, CA
| | - Karl A. Lorenz
- From the Johns Hopkins University, Baltimore, MD; Veterans Affairs Greater Los Angeles Healthcare System; David Geffen School of Medicine at University of California at Los Angeles, Los Angeles; and RAND Health, Santa Monica; and University of California, Irvine, CA
| | - Arash Naeim
- From the Johns Hopkins University, Baltimore, MD; Veterans Affairs Greater Los Angeles Healthcare System; David Geffen School of Medicine at University of California at Los Angeles, Los Angeles; and RAND Health, Santa Monica; and University of California, Irvine, CA
| | - Homayoon Sanati
- From the Johns Hopkins University, Baltimore, MD; Veterans Affairs Greater Los Angeles Healthcare System; David Geffen School of Medicine at University of California at Los Angeles, Los Angeles; and RAND Health, Santa Monica; and University of California, Irvine, CA
| | - Anne Walling
- From the Johns Hopkins University, Baltimore, MD; Veterans Affairs Greater Los Angeles Healthcare System; David Geffen School of Medicine at University of California at Los Angeles, Los Angeles; and RAND Health, Santa Monica; and University of California, Irvine, CA
| | - Steven M. Asch
- From the Johns Hopkins University, Baltimore, MD; Veterans Affairs Greater Los Angeles Healthcare System; David Geffen School of Medicine at University of California at Los Angeles, Los Angeles; and RAND Health, Santa Monica; and University of California, Irvine, CA
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111
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Reuzel RPB, Hasselaar GJ, Vissers KCP, van der Wilt GJ, Groenewoud JMM, Crul BJP. Inappropriateness of using opioids for end-stage palliative sedation: a Dutch study. Palliat Med 2008; 22:641-6. [PMID: 18612030 DOI: 10.1177/0269216308091867] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To be able to distinguish end-stage palliative sedation from euthanasia without having to refer to intentions that are difficult to verify, physicians must be able to manage palliative sedation appropriately (i.e., see that death is not hastened as a result of disproportionate medication). In the present study, we assessed whether or not this requirement is met in the Netherlands. We sent a retrospective questionnaire to 1,464 medical specialists, general practitioners, and nursing home physicians in the Netherlands. Furthermore, we held two sets of 20 and 22 semi-structured in-depth interviews with general practitioners, internists, lung specialists, and nursing home physicians. Although most guidelines discourage the administration of opioids alone for purposes of palliative sedation, opioids alone were administered for 22% of all the patients reported upon. Those physicians who were more experienced, general practitioners, and physicians who had consulted a palliative care expert administered only opioids significantly less often than the other physicians. The interviewees reported difficulties in assessing the appropriateness of medication, feeling uncertain about the pharmacokinetics of drugs used in moribund patients. Given that no more than 2% of the respondents perceived palliative sedation to be used as a form of euthanasia and that the use of opioids alone was not associated with shorter survival rates, the inappropriate use of opioids can only be attributed to a lack of knowledge or skill and/or a tradition of alleviating refractory dyspnoea with the use of opioids and not as an intentional means of hastening death.
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Affiliation(s)
- R P B Reuzel
- Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands.
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112
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Kompanje EJO, van der Hoven B, Bakker J. Anticipation of distress after discontinuation of mechanical ventilation in the ICU at the end of life. Intensive Care Med 2008; 34:1593-9. [PMID: 18516588 PMCID: PMC2517089 DOI: 10.1007/s00134-008-1172-y] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Accepted: 02/20/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND A considerable number of patients admitted to the intensive care unit (ICU) die following withdrawal of mechanical ventilation. After discontinuation of ventilation without proper preparation, excessive respiratory secretion is common, resulting in a 'death rattle'. Post-extubation stridor can give rise to the relatives' perception that the patient is choking and suffering. Existing protocols lack adequate anticipatory preparation to respond to all distressing symptoms. METHODS We analyzed existing treatment strategies in distressing symptoms after discontinuation of mechanical ventilation. CONCLUSION The actual period of discontinuation of mechanical ventilation can be very short, but thoughtful anticipation of distressing symptoms takes time. There is an ethical responsibility to anticipate and treat (iatrogenic) symptoms such as pain, dyspnea-associated respiratory distress, anxiety, delirium, post-extubation stridor, and excessive broncho-pulmonary secretions. This makes withdrawal of mechanical ventilation in ICU patients a thoughtful process, taking palliative actions instead of fast terminal actions. We developed a flowchart covering all possible distressing symptoms that can occur after withdrawal of mechanical ventilation and extubation. We recommend a two-phase process. Six hours before extubation, enteral feeding should be stopped and parenteral fluids reduced, overhydrated patients should be dehydrated with furosemide, administration of sedatives (for distress) and opioids (for pain and/or dyspnea) should be continued or started and methylprednisolone should be given in anticipation of stridor after extubation. Thirty minutes before extubation, Butylscopolamine should be given and methylprednisolone repeated. After this the patient should be extubated to secure a dying process as natural as possible with the lowest burden due to distress.
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Affiliation(s)
- E J O Kompanje
- Department of Intensive Care, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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113
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Ben-Aharon I, Gafter-Gvili A, Paul M, Leibovici L, Stemmer SM. Interventions for alleviating cancer-related dyspnea: a systematic review. J Clin Oncol 2008; 26:2396-404. [PMID: 18467732 DOI: 10.1200/jco.2007.15.5796] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Dyspnea is one of the most distressing symptoms experienced by terminally ill cancer patients. This study aimed to evaluate the role of interventions for the palliation of dyspnea. METHODS We conducted a systematic review of randomized controlled trials assessing all pharmacologic and nonpharmacologic interventions for dyspnea palliation in cancer patients, and searched the Cochrane Library, MEDLINE, conference proceedings, and references. Two reviewers independently appraised the quality of trials and extracted data. RESULTS Our search yielded 18 trials. Fourteen evaluated pharmacologic interventions: seven assessing opioids (a total of 256 patients), five assessing oxygen (137 patients), one assessing helium-enriched air, and one assessing furosemide. Four trials evaluated nonpharmacologic interventions (403 patients). The administration of subcutaneous morphine resulted in a significant reduction in dyspnea Visual Analog Scale (VAS) compared with placebo. No difference was observed in dyspnea VAS score when nebulized morphine was compared with subcutaneous morphine, although patients preferred the nebulized route. The addition of benzodiazepines to morphine was significantly more effective than morphine alone, without additional adverse effects. Oxygen was not superior to air for alleviating dyspnea, except for patients with hypoxemia. Nursing-led interventions improved breathlessness. Acupuncture was not beneficial. CONCLUSION Our review supports the use of opioids for dyspnea relief in cancer patients. The use of supplemental oxygen to alleviate dyspnea can be recommended only in patients with hypoxemia. Nursing-led nonpharmacologic interventions seem valuable. Only a few studies addressing this question were performed. Thus, further studies evaluating interventions for alleviating dyspnea are warranted.
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Affiliation(s)
- Irit Ben-Aharon
- Institute of Oncology, Davidoff Center, Rabin Medical Center Campus, 49100 Petah-Tiqva, Israel.
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114
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Bonnichon A, Le Floch H, Rivière F, Staub E, Mairovitz A, Marotel C, Vaylet F, Margery J. [Dyspnea in lung cancer]. REVUE DE PNEUMOLOGIE CLINIQUE 2008; 64:62-68. [PMID: 18589285 DOI: 10.1016/j.pneumo.2008.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Dyspnea is a subjective symptom defined as an experience of uncomfortable and difficult breathing which strongly affects the quality of life. It is the most common symptom in lung cancer but its physiopathology remains unclear. Dyspnea is due to cancer itself, specific therapies or comorbidities. To evaluate intensity of dyspnea, analogue visual and verbal rating scales need to be preferred. Diagnosis of underlying cause, based on rational and non invasive strategy is needed to perform effective treatment if possible. Despite its frequency, few therapies are really effective, except nonpharmacologic measures: only morphine can be actually recommend, especially with naive patients. In palliative cases, if dyspnea is uncontrolled, benzodiazepine can be used and may represent ethic approach.
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Affiliation(s)
- A Bonnichon
- Service des Maladies Respiratoires, Hôpital d'Instruction des Armées Percy, 101 Avenue Henri-Barbusse, 92140 Clamart, France.
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115
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Booth S, Moosavi SH, Higginson IJ. The etiology and management of intractable breathlessness in patients with advanced cancer: a systematic review of pharmacological therapy. ACTA ACUST UNITED AC 2008; 5:90-100. [PMID: 18235441 DOI: 10.1038/ncponc1034] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Accepted: 09/03/2007] [Indexed: 11/09/2022]
Abstract
Intractable breathlessness is a common, devastating symptom of advanced cancer causing distress and isolation for patients and families. In advanced cancer, breathlessness is complex and usually multifactorial and its severity unrelated to measurable pulmonary function or disease status. Therapeutic advances in the clinical management of dyspnea are limited and it remains difficult to treat successfully. There is growing interest in the palliation of breathlessness, and recent work has shown that a systematic, evidence-based approach by a committed multidisciplinary team can improve lives considerably. Where such care is lacking it may be owing to therapeutic nihilism in clinicians untrained in the management of chronic breathlessness and unaware that there are options other than endurance. Optimum management involves pharmacological treatment (principally opioids, occasionally oxygen and anxiolytics) and nonpharmacological interventions (including use of a fan, a tailor-made exercise program, and psychoeducational support for patient and family) with the use of parenteral opioids and sedation at the end of life when appropriate. Effective care centers on the patient's needs and goals. Priorities in breathlessness research include studies on: neuroimaging, the effectiveness of new interventions, the efficacy, safety, and dosing regimens of opioids, the contribution of deconditioning, and the effect of preventing or reversing breathlessness.
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Affiliation(s)
- Sara Booth
- Cambridge University NHS Foundation Trust Hospital, UK.
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116
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Scotté F, Riquet M, Oudard S. [Role of supportive care in lung cancer]. REVUE DE PNEUMOLOGIE CLINIQUE 2008; 64:118-124. [PMID: 18589294 DOI: 10.1016/j.pneumo.2008.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Lung cancer is a bad prognostic illness with a limited survival and many side effects related to treatment used. Supportive care in cancer attends to enhance patient care among cancer and treatments suffering. Opioids are one of the most important treatments in the management of dyspnoea and pain. Every new drug in supportive care is tested to diminish side effects of treatment like erythropoietin against anemia or aprepitant against emesis. Many trials are developed to enhance this supportive care especially in lung cancer management.
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Affiliation(s)
- F Scotté
- Service d'Oncologie Médicale, Hôpital Européen Georges-Pompidou, AP-HP, 20 Rue Leblanc, 75015 Paris, France.
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117
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The management of dyspnea in cancer patients: a systematic review. Support Care Cancer 2008; 16:329-37. [DOI: 10.1007/s00520-007-0389-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Accepted: 12/05/2007] [Indexed: 10/22/2022]
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118
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Abstract
This paper is the 29th consecutive installment of the annual review of research concerning the endogenous opioid system, now spanning 30 years of research. It summarizes papers published during 2006 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior (Section 2), and the roles of these opioid peptides and receptors in pain and analgesia (Section 3); stress and social status (Section 4); tolerance and dependence (Section 5); learning and memory (Section 6); eating and drinking (Section 7); alcohol and drugs of abuse (Section 8); sexual activity and hormones, pregnancy, development and endocrinology (Section 9); mental illness and mood (Section 10); seizures and neurological disorders (Section 11); electrical-related activity and neurophysiology (Section 12); general activity and locomotion (Section 13); gastrointestinal, renal and hepatic functions (Section 14); cardiovascular responses (Section 15); respiration and thermoregulation (Section 16); and immunological responses (Section 17).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, CUNY, 65-30 Kissena Blvd., Flushing, NY 11367, United States.
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119
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Gartner V, Watzke H. [Palliative treatment. Basic principles and symptom control]. Wien Klin Wochenschr 2007; 118:123-33; quiz 134. [PMID: 17598319 DOI: 10.1007/s11812-006-0011-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Verena Gartner
- Universitätsklinik für Innere Medizin I, Medizinische Universität Wien, Wien, Osterreich.
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120
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Currow DC, Plummer J, Frith P, Abernethy AP. Can We Predict Which Patients with Refractory Dyspnea Will Respond to Opioids? J Palliat Med 2007; 10:1031-6. [DOI: 10.1089/jpm.2007.9912] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- David C. Currow
- Department of Palliative and Supportive Services, Division of Medicine, South Australia, Australia
- Southern Adelaide Palliative Services, Repatriation General Hospital, Daw Park, South Australia, Australia
| | - John Plummer
- Pain Management Unit, Flinders University, Bedford Park, South Australia, Australia
| | - Peter Frith
- Southern Respiratory Services, Repatriation General Hospital, Daw Park, South Australia, Australia
| | - Amy P. Abernethy
- Department of Palliative and Supportive Services, Division of Medicine, South Australia, Australia
- Southern Adelaide Palliative Services, Repatriation General Hospital, Daw Park, South Australia, Australia
- Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
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Abstract
OBJECTIVES To review the current state of evidence for the nursing treatment of cancer-related dyspnea. DATA SOURCES Nursing and medical literature, published guidelines, and Cochrane Systematic reviews. CONCLUSION Limited evidence exists for the current strategies used to treat dyspnea among persons with cancer. IMPLICATIONS FOR NURSING PRACTICE Nurses must be cognizant of the level of evidence or the lack of scientific evidence supporting treatment strategies used. Keeping abreast of the developments in the area of dyspnea management is imperative as research adds to the current body of evidence. Nurses are uniquely positioned to add to the body of evidence through collaboration with nurse researchers.
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Sironi O, Sbanotto A, Banfi MG, Beltrami C. Midazolam as adjunct therapy to morphine to relieve dyspnea? J Pain Symptom Manage 2007; 33:233-4; author reply 234-6. [PMID: 17349490 DOI: 10.1016/j.jpainsymman.2006.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Indexed: 11/25/2022]
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Abstract
Dyspnea, defined as uncomfortable or labored breathing, is a common and often devastating cause of distress for patients and their caregivers with advanced cancer and other life-threatening illnesses. The mechanism by which dyspnea develops is not fully understood, but it involves integration of the central respiratory complex with the sensory (perceptual) cortex. The gold standard of diagnosis is patient self-report. Careful assessment should be undertaken to identify reversible existing causes. Systemic opioids are the first-line therapy for symptomatic management, along with other general comfort measures (positioning, cool air, calming environment). Medical or surgical management can be directed toward underlying causes. Advanced care planning should include discussions concerning the burdens and benefits of medical/surgical management of underlying causes of dyspnea to more effectively direct goals of care. This article reviews current literature on dyspnea, with a focus on items published since 2000.
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Thomas JR, von Gunten CF. Management of dyspnea. THE JOURNAL OF SUPPORTIVE ONCOLOGY 2004; 1:23-32; discussion 32-4. [PMID: 15352640 DOI: 10.1007/978-1-59745-291-5_1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Patients with cancer frequently report dyspnea, the uncomfortable awareness of breathing. Lung involvement with cancer does not predict its occurrence. Patients describe it as one of the most frightening and distressing symptoms, and patient self-report is the only reliable measure. Measurements of respiratory rate, oxygen saturation, and arterial blood gases do not measure dyspnea. Opioids in modest doses have been demonstrated to give effective relief of dyspnea, whether or not identifiable reversible causes exist. Medical management of dyspnea can be directed at the underlying cause when the potential benefits outweigh the burdens of such treatment. In rare cases where symptomatic treatment is unable to control dyspnea to the patient's satisfaction, sedation is an effective, ethical option.
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Affiliation(s)
- Jay R Thomas
- Center for Palliative Studies, San Diego Hospice, a teaching affiliate of the University of California, San Diego School of Medicine, USA.
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