1
|
Yamamoto Y, Tanaka S, Matsuura K, Yamamoto S, Urano K, Okita J, Kato E, Odagiri T, Deguchi Y. Effectiveness of opioid switching for dyspnea and its predictors in cancer patients: a single-center retrospective observational study. Jpn J Clin Oncol 2024; 54:549-555. [PMID: 38323655 DOI: 10.1093/jjco/hyae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/16/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Morphine is the most used opioid for dyspnea, but other opioids such as oxycodone and fentanyl are increasingly used, and opioid switching to these is sometimes undertaken. No studies have verified the effectiveness of opioid switching for relief of dyspnea. We retrospectively investigated the effectiveness of opioid switching for dyspnea and its predictors. METHODS All patients with opioid switching for dyspnea during hospitalization at Komaki City Hospital from January 2019 to August 2022 were included. Opioid switching was defined as a change to another opioid, and the assessment period for evaluating the effectiveness and adverse events of opioid switching was set as 1 week. Patients with Numeric Rating Scale or Japanese version of the Support Team Assessment Schedule reduction for dyspnea of at least 1, or with clear improvement based on medical records, were considered valid. Mitigating factors for dyspnea were identified using logistic regression analysis. RESULTS Of the 976 patients with opioid switching, 57 patients had opioid switching for relief of dyspnea. Of these, opioid switching was effective in 21 patients (36.8%). In a multivariate analysis, older patients (odds ratio: 5.52, 95% CI: 1.50-20.20, P < 0.01), short prognosis for post-opioid switching (odds ratio: 0.20, 95% CI: 0.04-0.87, P = 0.03) and cachexia (odds ratio: 0.12, 95% CI: 0.02-0.64, P < 0.01) were significantly associated with opioid switching effects for dyspnea. There were no serious adverse events after opioid switching. CONCLUSION This study indicates that opioid switching for dyspnea may have some effect. Furthermore, opioid switching for dyspnea may be more effective in older patients and less effective in terminally ill patients or in those with cachexia.
Collapse
Affiliation(s)
| | - Shion Tanaka
- Department of Clinical Pharmacy, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
| | - Katsuhiko Matsuura
- Department of Clinical Pharmacy, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
| | - Seiji Yamamoto
- Department of Clinical Pharmacy, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
| | - Kimihiko Urano
- Department of Clinical Pharmacy, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
| | - Junya Okita
- Department of Palliative Care, Komaki City Hospital, Komaki, Aichi, Japan
| | - Eisuke Kato
- Department of Palliative Care, Komaki City Hospital, Komaki, Aichi, Japan
| | - Takuya Odagiri
- Department of Palliative Care, Komaki City Hospital, Komaki, Aichi, Japan
- Department of Palliative Care, Seino Kosei Hospital, Gifu Seino Medical Center, Gifu, Japan
| | - Yuko Deguchi
- Departments of Pharmacy, Komaki City Hospital, Komaki, Aichi, Japan
| |
Collapse
|
2
|
Phillips I, Deans M, Walton A, Vallet M, Mencnarowksi J, McMillan D, Peacock C, Hall P, O'Brien F, Stares M, Mackean M, Plant T, Grecian R, Allan L, Petrie R, Blues D, Haddad S, Barrie C. Early prehabilitation reduces admissions and time in hospital in patients with newly diagnosed lung cancer. BMJ Support Palliat Care 2024:spcare-2024-004869. [PMID: 38631891 DOI: 10.1136/spcare-2024-004869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES Lung cancer is the leading cause of cancer death in the UK. Prehabilitation aims to maximise patient fitness and minimise the negative impact of anticancer treatment. What constitutes prehabilitation before non-surgical anticancer treatment is not well established. We present data from a pilot project of Early prehabilitation In lung Cancer. METHODS All new patients with likely advanced lung cancer were offered prehabilitation at respiratory clinic, if fit for further investigation. Prehabilitation included assessment and appropriate intervention from a consultant in palliative medicine, registered dietitian and rehabilitation physiotherapist. Four objective endpoints were identified, namely admissions to hospital, time spent in the hospital, treatment rates and overall survival. Outcomes were to be compared with 178 prehab eligible historical controls diagnosed from 2019 to 2021. RESULTS From July 2021 to June 2023, 65 patients underwent prehabilitation and 72% of patients underwent all 3 interventions. 54 patients had a stage 3 or 4 lung cancer. In the prehab group, fewer patients attended Accident and Emergency (31.5 vs 37.4 attendances per 100 patients) and fewer were admitted (51.9 vs 67.9) when compared with historical controls. Those receiving prehab spent a lot less time in the hospital (129.7 vs 543.5 days per 100 patients) with shorter admissions (2.5 vs 8 days). Systemic anticancer treatment rates increased in the short term but were broadly similar overall. Median survival was higher in the prehabilitation group (0.73 vs 0.41 years, p=0.046). CONCLUSIONS Early prehabilitation appears to reduce time spent in the hospital. It may improve survival. Further work is required to understand its full effect on treatment rates.
Collapse
Affiliation(s)
- Iain Phillips
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland, UK
- Edinburgh University, Edinburgh, UK
| | - Maria Deans
- Cancer Information Team, Western General Hospital, Edinburgh, UK
| | - Abi Walton
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland, UK
- St Johns Hospital, Livingston, UK
| | | | | | | | | | | | | | | | - Melanie Mackean
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland, UK
| | | | | | - Lindsey Allan
- Department of Nutrition and Dietetics, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Rebecca Petrie
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland, UK
| | - Duncan Blues
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland, UK
| | - Suraiya Haddad
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland, UK
| | - Colin Barrie
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland, UK
- St Johns Hospital, Livingston, UK
| |
Collapse
|
3
|
Phillips I, Petrie R, Allan L, Hall P, Walton A, McMillan D, Peacock C, Primrose L, Vallet M, Mencnarowksi J, MacDonald N, Mackean M, Barrie C. Early prehabilitation in suspected locally advanced and metastatic lung cancer. BMJ Support Palliat Care 2024; 13:e908-e911. [PMID: 37495261 DOI: 10.1136/spcare-2023-004349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/03/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVES The most common treatment for locally advanced and metastatic lung cancer is best supportive care. Patients with lung cancer are often comorbid with a high symptom burden. We wanted to assess whether early prehabilitation was feasible in patients with likely lung cancer. METHODS Patients were offered prehabilitation if they were attending the new patient respiratory clinic, had a CT scan suggesting stage III or IV lung cancer and undergoing further investigations. Patients receiving palliative care were ineligible. All prehabilitation patients were referred to a palliative medicine physician, registered dietitian and rehabilitation physiotherapist. RESULTS 50 patients underwent prehabilitation between June 2021 and August 2022. The median age was 72 years (range 54-89 years). 48 patients had lung cancer. 84% of patients attended all three interventions.Half of the palliative care consultations focused on pain. Half of the patients seen had a change in medication. 25% of patients' weights were stable, 32% required a food-first strategy and 33% required oral nutritional supplements. 57% of patients discussed managing breathlessness with the physiotherapist. CONCLUSIONS Early prehabilitation is feasible alongside the investigation of locally advanced and metastatic lung cancer. Further work will aim to assess its impact on admission to the hospital, survival and treatment rates.
Collapse
Affiliation(s)
- Iain Phillips
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - Rebecca Petrie
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - Lindsey Allan
- Department of Nutrition and Dietetics, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Peter Hall
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - Abi Walton
- Oncology department, St Johns Hospital, Livingston, UK
| | | | | | | | - Mahéva Vallet
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | | | | | - Melanie Mackean
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - Colin Barrie
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
- Oncology department, St Johns Hospital, Livingston, UK
| |
Collapse
|
4
|
Takagi Y, Sato J, Yamamoto Y, Matsunuma R, Watanabe H, Mori M, Hasegawa T, Matsuda Y, Kako J, Kasahara Y, Goya S, Kohara H, Nakayama T, Yamaguchi T. Opioids for the management of dyspnea in cancer patients: a systematic review and meta-analysis. Int J Clin Oncol 2023:10.1007/s10147-023-02362-6. [PMID: 37338727 PMCID: PMC10390357 DOI: 10.1007/s10147-023-02362-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/23/2023] [Indexed: 06/21/2023]
Abstract
Dyspnea is a prevalent symptom that significantly reduces quality of life of cancer patients. Palliative treatment is necessary when the symptoms do not respond to treatment for their cause. Opioids are widely used as pharmacological therapy, but evidence for individual agents is inconsistent. The purpose of this study was to evaluate the efficacy and safety of opioids for dyspnea in cancer patients. We searched the CENTRAL, MEDLINE, EMBASE, and ICHUSHI for studies using opioids for dyspnea in adult cancer patients reported by September 2019. Screening of the retrieved literature and assessment of risk of bias and outcomes were performed by two independent authors. A meta-analysis was performed on the primary endpoint, relief of dyspnea, and secondary endpoints including quality of life, somnolence as a side effect, and serious adverse events. Twelve randomized controlled trials were evaluated regarding relief of dyspnea. Somnolence and serious adverse events were evaluated in seven and four randomized controlled trials, respectively, but no randomized controlled trials were evaluable for quality of life. Overall, opioids were more effective than placebo for dyspnea (standardized mean difference - 0.43, 95% confidence interval [CI] - 0.75 to - 0.12). Although significant difference was found between systemic morphine and placebo in the drug-specific analysis, no significant difference could be detected in the other analyses. Systemic administration of opioids is more effective than placebo in relieving dyspnea in cancer patients. Robust evidence on the efficacy and safety of opioids on dyspnea in cancer patients is lacking, and further studies are needed.
Collapse
Affiliation(s)
- Yusuke Takagi
- Department of Palliative Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
| | - Junya Sato
- Department of Pharmacy, International University of Health and Welfare Hospital, Nasu-Shiobara, Japan
| | | | - Ryo Matsunuma
- Department of Palliative Medicine, Konan Medical Center, Kobe, Japan
| | | | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Takaaki Hasegawa
- Center for Psycho-Oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Jun Kako
- College of Nursing Art and Science, University of Hyogo, Kobe, Japan
| | - Yoko Kasahara
- Department of Pharmacy, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Sho Goya
- Department of Respiratory Medicine, Kinki Central Hospital of the Mutual Aid Association of Public School Teachers, Itami, Japan
| | - Hiroyuki Kohara
- Department of Internal Medicine, Hatsukaichi Memorial Hospital, Hatsukaichi, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University, Kyoto, Japan
| | - Takashi Yamaguchi
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
5
|
Lo SB, Svensson AD, Presley CJ, Andersen BL. A cognitive-behavioral model of dyspnea: Qualitative interviews with individuals with advanced lung cancer. Palliat Support Care 2023; 21:1-8. [PMID: 37249018 DOI: 10.1017/s1478951523000640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Shortness of breath, or dyspnea, is the subjective experience of breathing discomfort and is a common, distressing, and debilitating symptom of lung cancer. There are no efficacious pharmacological treatments, but there is suggestive evidence that cognitive-behavioral treatments could relieve dyspnea. For this, understanding the psychological, behavioral, and social factors that may affect dyspnea severity is critical. To this end, patients with dyspnea were interviewed with questions framed by the cognitive-behavioral model-emphasizing thoughts, emotions, and behaviors as contributors and outcomes of dyspnea. METHODS Two trained individuals conducted semi-structured interviews with lung cancer patients (N = 15) reporting current dyspnea. Interviews assessed patients' cognitive-behavioral experiences with dyspnea. Study personnel used a grounded theory approach for qualitative analysis to code the interviews. Inter-rater reliability of codes was high (κ = 0.90). RESULTS Thoughts: Most common were patients' catastrophic thoughts about their health and receiving enough oxygen when breathless. Emotions: Anxiety about dyspnea was the most common, followed by anger, sadness, and shame related to dyspnea. Behaviors: Patients rested and took deep breaths to relieve acute episodes of dyspnea. To reduce the likelihood of dyspnea, patients planned their daily activity or reduced their physical activity at the expense of engagement in hobbies and functional activities. SIGNIFICANCE OF RESULTS Patients identified cognitive-behavioral factors (thoughts, emotions, and behaviors) that coalesce with dyspnea. The data provide meaningful insights into potential cognitive-behavioral interventions that could target contributors to dyspnea.
Collapse
Affiliation(s)
- Stephen B Lo
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Aubrey D Svensson
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Carolyn J Presley
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center and The James Cancer Hospital/Solove Research Institute, Columbus, OH, USA
| | | |
Collapse
|
6
|
Kim JW, Park EY. Self-management of oxygen and bronchodilators to relieve the dyspnoea of lung cancer with pneumoconiosis. Int J Palliat Nurs 2021; 26:167-174. [PMID: 32378485 DOI: 10.12968/ijpn.2020.26.4.167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study aimed to evaluate the level of dyspnoea and the self-management strategies used to alleviate dyspnoea in lung cancer patients with concurrent pneumoconiosis, particularly oxygen therapy and bronchodilator treatment. Furthermore, the authors aimed to determine the factors associated with such self-management and to provide a basis for developing an applicable and safe treatment plan for alleviating dyspnoea. METHOD This study involved a cross-sectional survey. Data were collected using self-report questionnaires from 79 participants between January and July 2016, and self-management strategies were analysed using analysis of variance and multiple logistic regression analysis. RESULTS In terms of the self-management practices employed to relieve dyspnoea, 53.2% of the patients adjusted their oxygen intake and 70.9% used bronchodilators over the prescribed dosage. Adjusting the oxygen intake was not significantly associated with any of the patient characteristics. The factors related to increased bronchodilator use were the presence of comorbidities, cardiopulmonary function, subjective respiratory distress, activities of daily living, and the number of prescribed bronchodilators. CONCLUSION Dyspnoea is a severe critical condition, and urgent management of its clinical symptoms is required. Healthcare professionals who care for patients with lung cancer with pneumoconiosis should pay attention to the dyspnoea and manage it based on clinical evidence. Development of customised, integrated nursing treatment plans is needed to alleviate dyspnoea in patients with complications and chronic dyspnoea who have low daily activity levels.
Collapse
Affiliation(s)
- Jung Won Kim
- Assistant Manager, Infection Control Team, Korea Workers' Compensation and Welfare Service, Ansan Hospital, Gyeonggi-do, South Korea
| | - Eun Young Park
- College of Nursing, Gachon University, Incheon, South Korea
| |
Collapse
|
7
|
Symptom response analysis of a randomized controlled trial of reflexology for symptom management among women with advanced breast cancer. Support Care Cancer 2019; 28:1395-1404. [PMID: 31267277 DOI: 10.1007/s00520-019-04959-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 06/19/2019] [Indexed: 11/12/2022]
Abstract
PURPOSE To examine symptom responses resulting from a home-based reflexology intervention delivered by a friend/family caregivers to women with advanced breast cancer undergoing chemotherapy, targeted, and/or hormonal therapy. METHODS Patient-caregiver dyads (N = 256) were randomized to 4 weekly reflexology sessions or attention control. Caregivers in the intervention group were trained by a reflexology practitioner in a 30-min protocol. During the 4 weeks, both groups completed telephone symptom assessments using the M. D. Anderson Symptom Inventory. Those who completed at least one weekly call were included in this secondary analysis (N = 209). Each symptom was categorized as mild, moderate, or severe using established interference-based cut-points. Symptom response meant an improvement by at least one category or remaining mild. Symptom responses were treated as multiple events within patients and analyzed using generalized estimating equations technique. RESULTS Reflexology was more successful than attention control in producing responses for pain (OR = 1.84, 95% CI (1.05, 3.23), p = 0.03), with no significant differences for other symptoms. In the reflexology group, greater probability of response across all symptoms was associated with lower number of comorbid condition and lower depressive symptomatology at baseline. Compared to odds of responses on pain (chosen as a referent symptom), greater odds of symptom response were found for disturbed sleep and difficulty remembering with older aged participants. CONCLUSIONS Home-based caregiver-delivered reflexology was helpful in decreasing patient-reported pain. Age, comorbid conditions, and depression are potentially important tailoring factors for future research and can be used to identify patients who may benefit from reflexology. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01582971.
Collapse
|
8
|
Lovell N, Etkind SN, Bajwah S, Maddocks M, Higginson IJ. Control and Context Are Central for People With Advanced Illness Experiencing Breathlessness: A Systematic Review and Thematic Synthesis. J Pain Symptom Manage 2019; 57:140-155.e2. [PMID: 30291949 DOI: 10.1016/j.jpainsymman.2018.09.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/24/2018] [Accepted: 09/26/2018] [Indexed: 12/01/2022]
Abstract
CONTEXT Breathlessness is common and distressing in advanced illness. It is a challenge to assess, with few effective treatment options. To evaluate new treatments, appropriate outcome measures that reflect the concerns of people experiencing breathlessness are needed. OBJECTIVES The objective of this study was to systematically review and synthesize the main concerns of people with advanced illness experiencing breathlessness to guide comprehensive clinical assessment and inform future outcome measurement in clinical practice and research. METHODS This is a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. MEDLINE (1946-2017), PsycINFO (1806-2017), and EMBASE (1974-2017), as well as key journals, gray literature, reference lists, and citation searches, identified qualitative studies exploring the concerns of people living with breathlessness. Included studies were quality-assessed using the Critical Appraisal Skills Program checklist and analyzed using thematic synthesis. RESULTS We included 38 studies with 672 participants. Concerns were identified across six domains of "total" breathlessness: physical, emotional, spiritual, social, control, and context (chronic and episodic breathlessness). Four of these have been previously identified in the concept of "total dyspnea." Control and context have been newly identified as important, particularly in their influence on coping and help-seeking behavior. The importance of social participation, impact on relationships, and loss of perceived role within social and spiritual domains also emerged as being significant to individuals. CONCLUSION People with advanced illness living with breathlessness have concerns in multiple domains, supporting a concept of "total breathlessness." This adapted model can help to guide comprehensive clinical assessment and inform future outcome measurement in clinical practice and research.
Collapse
Affiliation(s)
- Natasha Lovell
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom.
| | - Simon N Etkind
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| | - Sabrina Bajwah
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| |
Collapse
|
9
|
Larsen KSR, Petersen AK, Lisby M, Knudsen MV. Dyspnoea and self-management strategies in patients admitted to the emergency department: A study of patients' experiences. J Clin Nurs 2018; 27:4112-4118. [PMID: 29893435 DOI: 10.1111/jocn.14560] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 04/24/2018] [Accepted: 06/03/2018] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVE To explore patients' experiences of acute dyspnoea, physical functioning and perspectives on course of illness prior to admission to the emergency department. BACKGROUND Many emergency admissions are considered unnecessary and avoidable. In this perspective, it seems relevant to gain insight into the patients' perspective on acute dyspnoea and the need for emergency admission. However, only few studies have investigated reasons for emergency admission from a patient perspective. DESIGN A qualitative study was conducted with semi-structured interviews among six patients previously admitted to the emergency department due to dyspnoea. Data collection and analysis were carried out according to Kvale & Brinkmann using meaning condensation. FINDINGS Dyspnoea was experienced as an unpleasant breathlessness in the form of pain or suffocation, which limited usual physical activities, negatively impacting on quality of life. Self-management strategies such as medication, breathing exercises, distraction from breathing, and mental and physical relaxation in general were used to avoid hospital admission. The chronically ill patients saw the following ways to alternate course of disease to avoid admissions to the emergency department: easier access to specialised emergency medical care, medical supplies in the patient's home and making existing physical exercise programmes more accessible and interesting. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE It would be relevant to further investigate whether prehospital interventions may remedy acute dyspnoea among chronically ill patients, and whether such interventions are cost-effective.
Collapse
Affiliation(s)
- Karoline Stentoft Rybjerg Larsen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Centre of Research in Rehabilitation (CORIR), Aarhus University, Aarhus N, Denmark
| | - Annemette Krintel Petersen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Centre of Research in Rehabilitation (CORIR), Aarhus University, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Marianne Lisby
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.,Emergency Department, Aarhus University Hospital, Aarhus N, Denmark
| | - Marie Veje Knudsen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Centre of Research in Rehabilitation (CORIR), Aarhus University, Aarhus N, Denmark
| |
Collapse
|
10
|
Stowe E, Wagland R. A qualitative exploration of distress associated with episodic breathlessness in advanced lung cancer. Eur J Oncol Nurs 2018; 34:76-81. [PMID: 29784142 DOI: 10.1016/j.ejon.2018.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 03/22/2018] [Accepted: 03/26/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE Breathlessness is a distressing symptom, particularly common in those with advanced lung cancer. Previous research has identified the symptom occurrence of episodic breathlessness, identifying average frequency, duration and severity of episodes, but has not explored the distress specifically associated with these episodes. This study explored the distress associated with episodic breathlessness for adults with advanced cancer and the relative impact of three elements; frequency, duration or severity. METHODS Semi-structured interviews were conducted with four participants with advanced lung cancer. Analysis adopted an interpretative phenomenological approach. RESULTS A complex relationship existed between distress caused by episodic breathlessness and its frequency, duration and severity for study participants. Episodic breathlessness had a significant impact on participant's perceptions of self and previous experience effected how distressed they were by their breathlessness. The emotional work created by the symptom was considerable for individuals. CONCLUSION The study highlights the importance of recognizing symptoms as a combination of different experiences that may each cause different levels of distress. Initial evidence is provided that the emotional work involved for patients to self-manage each separate element of breathlessness should be considered in its treatment.
Collapse
Affiliation(s)
- Emily Stowe
- St Clare Hospice, Hastingwood Road, Hastingwood, Essex, CM17 9JX, United Kingdom.
| | - Richard Wagland
- Faculty of Health Sciences, Building 67, Highfield, University of Southampton, SO17 1BJ, United Kingdom.
| |
Collapse
|
11
|
Hutchinson A, Barclay-Klingle N, Galvin K, Johnson MJ. Living with breathlessness: a systematic literature review and qualitative synthesis. Eur Respir J 2018; 51:51/2/1701477. [PMID: 29467199 DOI: 10.1183/13993003.01477-2017] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 12/09/2017] [Indexed: 02/03/2023]
Abstract
What is the experience of people living with breathlessness due to medical conditions, those caring for them and those treating them, with regard to quality of life and the nature of clinical interactions?Electronic databases (Ovid MEDLINE, Embase, CINAHL Plus and PsycINFO) were searched (January 1987 to October 2017; English language), for qualitative studies exploring the experience of chronic breathlessness (patients, carers and clinicians). Two independent reviewers screened titles, abstracts and papers retrieved against inclusion criteria. Disagreements were resolved with a third reviewer. Primary qualitative data were extracted and synthesised using thematic synthesis.Inclusion and synthesis of 101 out of 2303 international papers produced four descriptive themes: 1) widespread effects of breathlessness; 2) coping; 3) help-seeking behaviour; and 4) clinicians' responsiveness to the symptom of breathlessness. The themes were combined to form the concept of "breathing space", to show how engaged coping and appropriate help-seeking (patient) and attention to symptom (clinician) helps maximise the patient's quality of living with breathlessness.Breathlessness has widespread impact on both patient and carer and affects breathing space. The degree of breathing space is influenced by interaction between the patient's coping style, their help-seeking behaviour and their clinician's responsiveness to breathlessness itself, in addition to managing the underlying disease.
Collapse
|
12
|
Sugimura A, Ando S, Tamakoshi K. Palliative care and nursing support for patients experiencing dyspnoea. Int J Palliat Nurs 2017; 23:342-351. [PMID: 28756753 DOI: 10.12968/ijpn.2017.23.7.342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To investigate the association between the type of support provided by nurses for dyspnoea and palliative care practice in Japan, a cross-sectional questionnaire survey was conducted in 2015. Of the 535 questionnaires sent to nurses working at 22 designated cancer hospitals, 344 were returned. The questionnaire assessed the demographic characteristics of the nurses, nursing support for dyspnoea, and palliative care practice measured by the 'Palliative care self-reported practices scale'. Multivariate analysis showed that the domains of palliative care practice influenced the provision of nursing support for patients with dyspnoea. In conclusion, palliative care practice is important for supporting patients with dyspnoea, and nurses should possess the requisite knowledge and skills to deliver this care appropriately.
Collapse
Affiliation(s)
- Ayumi Sugimura
- Doctoral Program, Fundamental and Clinical Nursing, Department of Nursing, Nagoya University Graduate School of Medicine (Health Sciences) Nagoya, Japan
| | - Shoko Ando
- Fundamental and Clinical Nursing, Department of Nursing, Nagoya University Graduate School of Medicine (Health Sciences) Nagoya, Japan
| | - Koji Tamakoshi
- Nursing for Developmental Health, Department of Nursing, Nagoya University Graduate School of Medicine (Health Sciences) Nagoya, Japan
| |
Collapse
|
13
|
Simon ST, Weingärtner V, Higginson IJ, Benalia H, Gysels M, Murtagh FEM, Spicer J, Linde P, Voltz R, Bausewein C. "I Can Breathe Again!" Patients' Self-Management Strategies for Episodic Breathlessness in Advanced Disease, Derived From Qualitative Interviews. J Pain Symptom Manage 2016; 52:228-34. [PMID: 27220949 DOI: 10.1016/j.jpainsymman.2016.02.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 01/22/2016] [Accepted: 02/13/2016] [Indexed: 01/21/2023]
Abstract
CONTEXT Episodic breathlessness causes additional distress to breathless patients with advanced disease, but management is still insufficient and there is a lack of knowledge on effective coping strategies. OBJECTIVES The aim was to explore patients' self-management strategies for episodic breathlessness. METHODS In-depth interviews with patients suffering from episodic breathlessness as a result of chronic heart failure, chronic obstructive pulmonary disease, lung cancer, or motor neuron disease were conducted. Interviews were transcribed verbatim and analyzed guided by the analytic hierarchy of Framework analysis. RESULTS A total of 51 participants were interviewed (15 chronic heart failure, 14 chronic obstructive pulmonary disease, 13 lung cancer, and nine motor neuron disease; age, mean [SD], 68 [12], 41% women, median Karnofsky index 60%). They described six main strategies for coping with episodes of breathlessness: reduction of physical exertion, cognitive and psychological strategies, breathing techniques and positions, air and oxygen, drugs and medical devices, and environmental and other strategies. Some strategies were used in an opposing way, e.g., concentrating on the breathing vs. distraction from any thoughts of breathlessness or laying down flat vs. standing up and raising hands. CONCLUSION Patients used a number of different strategies to cope with episodic breathlessness, adding more detailed understanding of existing strategies for breathlessness. The findings, therefore, may provide a valuable aid for health care providers, affected patients, and their relatives.
Collapse
Affiliation(s)
- Steffen T Simon
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany; Center of Integrated Oncology (CIO) Cologne/Bonn, University Hospital of Cologne, Cologne, Germany; Institute of Palliative Care, Oldenburg, Germany.
| | - Vera Weingärtner
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany
| | - Irene J Higginson
- Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation-WHO Collaborating Centre for Palliative Care and Older People, King's College London, London, United Kingdom
| | - Hamid Benalia
- Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation-WHO Collaborating Centre for Palliative Care and Older People, King's College London, London, United Kingdom
| | - Marjolein Gysels
- Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation-WHO Collaborating Centre for Palliative Care and Older People, King's College London, London, United Kingdom
| | - Fliss E M Murtagh
- Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation-WHO Collaborating Centre for Palliative Care and Older People, King's College London, London, United Kingdom
| | - James Spicer
- Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation-WHO Collaborating Centre for Palliative Care and Older People, King's College London, London, United Kingdom; Division of Cancer Studies, King's College London, London, United Kingdom
| | - Philipp Linde
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany; Center of Integrated Oncology (CIO) Cologne/Bonn, University Hospital of Cologne, Cologne, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany; Center of Integrated Oncology (CIO) Cologne/Bonn, University Hospital of Cologne, Cologne, Germany
| | - Claudia Bausewein
- Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation-WHO Collaborating Centre for Palliative Care and Older People, King's College London, London, United Kingdom; Department for Palliative Medicine, University Hospital Munich, Munich, Germany
| |
Collapse
|
14
|
Chandrasekar D, Tribett E, Ramchandran K. Integrated Palliative Care and Oncologic Care in Non-Small-Cell Lung Cancer. Curr Treat Options Oncol 2016; 17:23. [PMID: 27032645 PMCID: PMC4819778 DOI: 10.1007/s11864-016-0397-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OPINION STATEMENT Palliative care integrated into standard medical oncologic care will transform the way we approach and practice oncologic care. Integration of appropriate components of palliative care into oncologic treatment using a pathway-based approach will be described in this review. Care pathways build on disease status (early, locally advanced, advanced) as well as patient and family needs. This allows for an individualized approach to care and is the best means for proactive screening, assessment, and intervention, to ensure that all palliative care needs are met throughout the continuum of care. Components of palliative care that will be discussed include assessment of physical symptoms, psychosocial distress, and spiritual distress. Specific components of these should be integrated based on disease trajectory, as well as clinical assessment. Palliative care should also include family and caregiver education, training, and support, from diagnosis through survivorship and end of life. Effective integration of palliative care interventions have the potential to impact quality of life and longevity for patients, as well as improve caregiver outcomes.
Collapse
Affiliation(s)
- Divya Chandrasekar
- />Hospice and Palliative Medicine, Stanford University School of Medicine, 2502 Galahad Court, San Jose, CA 95122 USA
| | - Erika Tribett
- />General Medical Disciplines, Stanford University School of Medicine, Medical School Office Building, 1265 Welch Road, MC 5475, Stanford, CA 94305 USA
| | - Kavitha Ramchandran
- />Outpatient Palliative Medicine, Stanford Cancer Institute, Medical School Office Building, 1265 Welch Road MC 5475, Stanford, CA 94305 USA
| |
Collapse
|
15
|
A causal model for fatigue in lung cancer patients receiving chemotherapy. Eur J Oncol Nurs 2016; 21:242-7. [DOI: 10.1016/j.ejon.2015.10.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/20/2015] [Accepted: 10/27/2015] [Indexed: 11/22/2022]
|
16
|
Abstract
Pulmonary rehabilitation, as a quality of life intervention, has a role to play in palliative care for lung cancer patients. Combining the art and skills of clinical care, physiological, and behavioral tools, pulmonary rehabilitation can serve to rebuild the functional capacity of patients limited by breathlessness and deconditioning. Exercise programs are the primary tool used to restore and rebuild the patient's endurance by challenging the entire pathway of oxygen transport and improving gas exchange. Other tools of pulmonary rehabilitation include breathing retraining, self-management skills, airway clearance techniques, bronchodilitation, smoking cessation and oxygen therapy. Pulmonary rehabilitation is now becoming a part of supportive care for patients undergoing chemotherapy and radiation therapy. The ability to be more active without suffering the consequences of dyspnea on exertion boosts the patient's self-efficacy and allows for an improved quality of life, so that lung cancer patients can participate in their family lives during this therapeutic challenge.
Collapse
|
17
|
Kloke M, Cherny N. Treatment of dyspnoea in advanced cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol 2015; 26 Suppl 5:v169-73. [PMID: 26314777 DOI: 10.1093/annonc/mdv306] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Affiliation(s)
- M Kloke
- Department of Palliative Medicine and Institute for Palliative Care, Kliniken Essen-Mitte, Academic Teaching Hospital University Essen-Duisburg, Essen, Germany
| | - N Cherny
- Department of Medical Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
| |
Collapse
|
18
|
Mosher CE, Ott MA, Hanna N, Jalal SI, Champion VL. Coping with physical and psychological symptoms: a qualitative study of advanced lung cancer patients and their family caregivers. Support Care Cancer 2015; 23:2053-60. [PMID: 25527242 PMCID: PMC4449810 DOI: 10.1007/s00520-014-2566-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 12/07/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Advanced lung cancer patients have high rates of multiple physical and psychological symptoms, and many of their family caregivers experience significant distress. However, little is known about strategies that these patients and their family caregivers employ to cope with physical and psychological symptoms. This study aimed to identify strategies for coping with various physical and psychological symptoms among advanced, symptomatic lung cancer patients and their primary family caregivers. METHODS Patients identified their primary family caregiver. Individual semi-structured qualitative interviews were conducted with 21 advanced, symptomatic lung cancer patients and primary family caregivers. Thematic analysis of interview data was framed by stress and coping theory. RESULTS Patients and caregivers reported maintaining a normal routine and turning to family and friends for support with symptom management, which often varied in its effectiveness. Whereas support from health-care professionals and complementary and alternative medicine were viewed favorably, reactions to Internet and in-person support groups were mixed due to the tragic nature of participants' stories. Several cognitive coping strategies were frequently reported (i.e., changing expectations, maintaining positivity, and avoiding illness-related thoughts) as well as religious coping strategies. CONCLUSIONS Results suggest that advanced lung cancer patients and caregivers may be more receptive to cognitive and religious approaches to symptom management and less receptive to peer support. Interventions should address the perceived effectiveness of support from family and friends.
Collapse
Affiliation(s)
- Catherine E Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA,
| | | | | | | | | |
Collapse
|
19
|
Abstract
BACKGROUND Patients with lung cancer are in need of effective strategies to modify symptom burden and improve health-related quality of life (HRQOL). One promising approach to symptom management is an 8-week mindfulness-based intervention, which incorporates meditation, breathing, and gentle yoga exercises. It requires few resources to implement, but has not been adequately tested with lung cancer patients. OBJECTIVE The purpose of this study was to obtain lung cancer patient perceptions of a mindfulness-based intervention. METHODS Eleven lung cancer patients participated in audio-taped focus group sessions led by the investigator. Discussion questions probed patient perceptions of mindfulness in terms of symptom management, including benefits and barriers to this therapy and ways the intervention may need to be adapted to accommodate them. RESULTS Three primary themes from the qualitative analysis include (1) awareness and interest, (2) perceived barriers and benefits, and (3) recommended adaptations. Specific perceptions included the importance of targeting key symptoms such as dyspnea, worry, and insomnia, whereas recommendations pointed out the need for a shorter duration than the standard 8-week protocol and a home-based approach for greater accessibility. CONCLUSIONS The design of mindfulness-based intervention protocols must consider unique characteristics of this vulnerable group, such as targeting specific symptoms, reducing the 8-week protocol, and a home-based offering. IMPLICATIONS FOR PRACTICE Nurses are integral to optimizing HRQOL and independent functioning for lung cancer patients. As lung cancer survivorship is extended, it becomes increasingly imperative that a range of supportive resources is available for patients to manage symptoms and improve HRQOL.
Collapse
|
20
|
Simon ST, Weingärtner V, Higginson IJ, Voltz R, Bausewein C. Definition, categorization, and terminology of episodic breathlessness: consensus by an international Delphi survey. J Pain Symptom Manage 2014; 47:828-38. [PMID: 24095285 DOI: 10.1016/j.jpainsymman.2013.06.013] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 06/10/2013] [Accepted: 06/16/2013] [Indexed: 01/15/2023]
Abstract
CONTEXT Episodic breathlessness is a common and distressing symptom in patients with advanced disease. Still, it is not yet clearly defined. OBJECTIVES The aim of this work was to develop an international definition, categorization, and terminology of episodic breathlessness. METHODS An online Delphi survey was conducted with international breathlessness experts. We used a structured questionnaire to identify specific aspects and reach agreement on a definition, categorization, and terminology (five-point Likert scale). Consensus was defined in advance as ≥70% agreement. RESULTS Thirty-one of 68 (45.6%), 29 of 67 (43.3%), and 33 of 67 (49.3%) experts responded in the first, second, and third rounds, respectively. Participants were 20-79 years old, about 60% male, and more than 75% rated their own breathlessness expertise as moderate to high. After three rounds, consensus was reached on a definition, categorization, and terminology (84.4%, 96.3%, and 92.9% agreement). The final definition includes general and qualitative aspects of the symptom, for example, time-limited severe worsening of intensity or unpleasantness of breathlessness in the patient's perception. Categories are predictable or unpredictable, depending on whether any triggers can be identified. CONCLUSION There is high agreement on clinical and operational aspects of episodic breathlessness in advanced disease among international experts. The consented definition and categorization may serve as a catalyst for clinical and basic research to improve symptom control and patients' quality of life.
Collapse
Affiliation(s)
- Steffen T Simon
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany; Centre for Integrated Oncology Cologne/Bonn, Clinical Trials Centre Cologne (BMBF 01KN1106), Cologne, Germany.
| | - Vera Weingärtner
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany
| | - Irene J Higginson
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation-WHO Collaborating Centre for Palliative Care and Older People, London, United Kingdom
| | - Raymond Voltz
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany; Centre for Integrated Oncology Cologne/Bonn, Clinical Trials Centre Cologne (BMBF 01KN1106), Cologne, Germany
| | - Claudia Bausewein
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation-WHO Collaborating Centre for Palliative Care and Older People, London, United Kingdom; Department for Palliative Medicine, University Hospital of Munich, Munich, Germany
| |
Collapse
|
21
|
Maguire R, Papadopoulou C, Kotronoulas G, Simpson MF, McPhelim J, Irvine L. A systematic review of supportive care needs of people living with lung cancer. Eur J Oncol Nurs 2013; 17:449-64. [PMID: 23246484 DOI: 10.1016/j.ejon.2012.10.013] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 10/23/2012] [Accepted: 10/30/2012] [Indexed: 11/18/2022]
Affiliation(s)
- Roma Maguire
- School of Nursing & Midwifery, University of Dundee, 11 Airlie Place, Dundee DD1 4HJ, UK.
| | | | | | | | | | | |
Collapse
|
22
|
Simon ST, Higginson IJ, Benalia H, Gysels M, Murtagh FEM, Spicer J, Bausewein C. Episodic and continuous breathlessness: a new categorization of breathlessness. J Pain Symptom Manage 2013; 45:1019-29. [PMID: 23017608 DOI: 10.1016/j.jpainsymman.2012.06.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 06/03/2012] [Accepted: 06/14/2012] [Indexed: 11/26/2022]
Abstract
CONTEXT Unlike pain, where the concept of breakthrough and background pain has been widely characterized and defined, breathlessness as a symptom has not yet been fully explored and has been rarely categorized. OBJECTIVES To explore patients' experiences and descriptions of breathlessness to categorize breathlessness. METHODS Qualitative study using in-depth interviews with patients suffering from four life-limiting and advanced diseases (chronic heart failure, chronic obstructive pulmonary disease, lung cancer, and motor neuron disease). Interviews were tape-recorded, transcribed verbatim, and analyzed using Framework analysis. RESULTS A total of 51 participants were interviewed (mean ± SD age 68.2 ± 11.6 years; 30 of 51 male; median Karnofsky 60%; mean ± SD breathlessness intensity 3.2 ± 1.7 of 10). Episodic breathlessness and continuous breathlessness were the main categories, with subcategories of triggered and non-triggered episodic breathlessness and continuous breathlessness for short and long periods. Episodic breathlessness triggered by exertion, non-triggered episodic breathlessness, and continuous breathlessness for a long period ("constant variable") were the most frequent and important categories with a high impact on daily living. Exertional breathlessness occurred in nearly all participants. Participants could differentiate episodic breathlessness (seconds, minutes, or hours) and continuous breathlessness (days, weeks, or months) by time. Episodic breathlessness occurred in isolation or in conjunction with continuous breathlessness. CONCLUSION Participants categorize their breathlessness by time and triggers. The categorization needs further verification, similar to that already established in pain, and can be used as a new evidence-based categorization to advance our understanding of this under-researched, yet high impact, symptom to optimize management.
Collapse
Affiliation(s)
- Steffen T Simon
- Department of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom.
| | | | | | | | | | | | | |
Collapse
|
23
|
Wood H, Connors S, Dogan S, Peel T. Individual experiences and impacts of a physiotherapist-led, non-pharmacological breathlessness programme for patients with intrathoracic malignancy: a qualitative study. Palliat Med 2013; 27:499-507. [PMID: 23128902 DOI: 10.1177/0269216312464093] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Non-pharmacological breathlessness management programmes have been shown to be beneficial in the management of lung cancer-related dyspnoea for more than 10 years. What is not so clear is how they work. AIM To evaluate how patients with intrathoracic malignancy (lung cancer or pleural mesothelioma) undergoing the non-pharmacological breathlessness management programmes benefited from the programme, using a qualitative methodology. DESIGN AND SETTING Consecutive patients completing the programme were invited to be interviewed (semi-structured and audio-recorded) about their experiences of the programme, what had helped them and how. Interviews were transcribed and analysed using interpretative phenomenological analysis. RESULTS Nine patients were interviewed. Seven major themes emerged, they are summarised as follows: (1) Mixed prior expectations of the programme, (2) flexibility of delivery and additional support needs, (3) physiotherapist attributes and skills in developing an effective helping relationship, (4) adoption of new techniques, (5) the effects and impact of the programme and new techniques, (6) difficulties and barriers to achieving change and (7) facing an uncertain future beyond the programme. CONCLUSION The non-pharmacological breathlessness management programme appears to offer a wide range of benefits to patients, including improving functional capacity, coping strategies and self-control. Such benefits are most likely to be due to a combination of breathing control, activity management and the therapist qualities.
Collapse
Affiliation(s)
- Helen Wood
- Department of Clinical Psychology, North Tyneside General Hospital, North Shields, UK
| | | | | | | |
Collapse
|
24
|
Simon ST, Bausewein C, Schildmann E, Higginson IJ, Magnussen H, Scheve C, Ramsenthaler C. Episodic breathlessness in patients with advanced disease: a systematic review. J Pain Symptom Manage 2013; 45:561-78. [PMID: 22921180 DOI: 10.1016/j.jpainsymman.2012.02.022] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 02/20/2012] [Accepted: 02/20/2012] [Indexed: 01/04/2023]
Abstract
CONTEXT Although episodic breathlessness (EB) is reported to be highly prevalent in advanced disease, our understanding about it is limited. OBJECTIVES The aim of this study was to systematically review and synthesize the evidence on EB regarding definition, characteristics, and patients' experiences. METHODS Systematic review using searches in six databases, hand search, and personal contacts with authors in the field. Search terms included the combination of "episodic" and "breathlessness" (and synonyms) with five different diseases. Selection criteria included patients with advanced disease and information about EB based on original research. All retrieved studies were reviewed by two independent investigators. RESULTS Twenty-seven studies (of 7584) were included in this review. Only eight studies explored EB as a primary outcome. EB is poorly defined. It is characterized by high prevalence (81%-85%), high frequency (daily), short duration (often less than 10 minutes), and severe peak intensity. EB either develops without any known trigger or is triggered by physical exertion, emotions, or environmental influences. CONCLUSION EB is a common symptom in patients with advanced disease, but information about characteristics and experiences is limited. As there is no common terminology, an agreed definition is needed to foster research to develop effective treatments for EB.
Collapse
|
25
|
Park SK, Stotts NA, Douglas MK, Donesky-Cuenco D, Carrieri-Kohlman V. Dyspnea coping strategies in Korean immigrants with asthma or chronic obstructive pulmonary disease. J Transcult Nurs 2013; 25:60-9. [PMID: 24346615 DOI: 10.1177/1043659612472709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Patients with lung disease develop coping strategies to relieve dyspnea. The coping strategies of Korean immigrants, however, are poorly understood. The purpose of this study was to describe the strategies that Korean immigrants with asthma or chronic obstructive pulmonary disease (COPD) use to cope with dyspnea and to compare similarities and differences in coping strategies between the two conditions. DESIGN Outpatients with asthma (n = 25) or COPD (n = 48) participated in a cross-sectional descriptive study. METHOD Open-ended questions and a structured instrument were used to describe coping strategies for dyspnea. Descriptive and inferential statistics were used to analyze the data. RESULTS The most prevalent strategy was "I keep still or rest." Korean immigrants also used traditional therapies to manage dyspnea. CONCLUSIONS Although the coping strategies of Korean immigrants were similar to those of other ethnic groups, they incorporated elements of Asian medical practice and herbs. This finding enables health care providers to better understand Korean immigrants' efforts to overcome dyspnea and to guide their patients' approach to coping.
Collapse
|
26
|
Thomas S, Bausewein C, Higginson I, Booth S. Breathlessness in cancer patients – Implications, management and challenges. Eur J Oncol Nurs 2011; 15:459-69. [DOI: 10.1016/j.ejon.2010.11.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 11/26/2010] [Accepted: 11/30/2010] [Indexed: 10/18/2022]
|
27
|
Management of dyspnea in advanced lung cancer: recent data and emerging concepts. Curr Opin Support Palliat Care 2010; 4:85-91. [DOI: 10.1097/spc.0b013e328339920d] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|