Breathlessness in cancer patients - Implications, management and challenges

European Journal of Oncology Nursing

Volumn 15, Issue 5, 2011, Pages 459-469

  Thomas, Shirley ^a   Bausewein, Claudia ^b   Higginson, Irene ^b   Booth, Sara ^c  

^a ADDENBROOKE S HOSPITAL   (United Kingdom)

^b KING'S COLLEGE LONDON   (United Kingdom)

^c UNIVERSITY OF CAMBRIDGE   (United Kingdom)

Author keywords

Assessment; Breathlessness dyspnoea; Cancer; Interventions; Management; Measurement; Non pharmacological; Palliative care; Pathophysiology; Pharmacological

Indexed keywords

DYSPNEA; HUMAN; META ANALYSIS (TOPIC); NEOPLASM; PATHOLOGY; RANDOMIZED CONTROLLED TRIAL (TOPIC); REVIEW; TREATMENT OUTCOME;

DYSPNEA; HUMANS; META-ANALYSIS AS TOPIC; NEOPLASMS; RANDOMIZED CONTROLLED TRIALS AS TOPIC; TREATMENT OUTCOME;

EID: 80055086098     PISSN: 14623889     EISSN: 15322122     Source Type: Journal    
DOI: 10.1016/j.ejon.2010.11.013     Document Type: Review

References (69)

1. American Thoracic Society Dyspnoea-mechanisms, assessment, and management: a consensus statement. American Journal of Respiratory and Critical Care Medicine 1999, 159:321-340.
2. Abernethy A., Currow D., Frith P., Fazekas B., McHugh A., Bui C. Randomised, double blind, placebo controlled crossover trial of sustained release morphine for the management of refractory dyspnoea. BMJ 2003, 327:523-528.
3. Abernethy A., Wheeler J. Total dyspnoea. Current Opinion in Supportive and Palliative Care 2008, 2:110-113.
4. Abernethy A., McDonald C., Frith P.A., Clark K., Herndon J.E., Marcello J., Young I.H., Bull J., Wilcock A., Booth S., Wheeler J.L., Tulsky J.A., Crockett A.J., Currow D.C. Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trial. Lancet 2010, 376:784-793.
5. Ahmedzai S., Laude E., Robertson A., Troy G., Vora V. A double-blind, randomised, controlled phase II trial of heliox28 gas mixture in lung cancer patients with dyspnoea on exertion. British Journal of Cancer 2004, 90:366-371.
6. Bausewein C., Malik F., Booth S., Higginson I. Recent developments in managing breathlessness International researchers' meeting on Breathlessness in London, November 2006. Progress in Palliative Care 2007, 15(6):279-284.
7. Bausewein C., Booth S., Gysels M., Higginson I. Non-pharmacological interventions for breathlessness in advanced stages of malignant and non-malignant diseases. Cochrane Database of Systematic Reviews 2008, (2). Art.No.:CD005623, CD005623.pub2. 10.1002/14651858.
8. Bausewein C., Booth S., Higginson I. Measurement of dyspnoea in the clinical rather than the research setting. Current Opinion in Supportive and Palliative Care 2008, 2:95-99.
9. Bausewein C., Booth S., Gysels M., Kühnbach R., Haberland B., Higginson I.J. Individual breathlessness trajectories do not match summary trajectories in advanced cancer and chronic obstructive pulmonary disease: results from a longitudinal study. Palliative Medicine 2010, 24:777-786. published online 16 September 2010a. 10.1177/0269216310378785.
10. Bausewein C., Booth S., Gysels M., Kühnbach R., Haberland B., Higginson I.J. A comparison of symptoms and palliative care needs in COPD and cancer: a cross-sectional survey. Journal of Palliative Medicine 2010, 13:1109-1118.
11. Bausewein, C., 2009. Course and non-pharmacological management of breathlessness in advanced disease- a comparison between cancer and COPD, PhD, University of London.
12. Beach Schartzstein The genesis of breathlessness. What do we understand?. Dyspnoea in Advanced Disease - A Guide to Clinical Management 2006, OxfordUniversity Press. S. Booth, D. Dudgeon (Eds.).
13. Booth S., Silvester S., Todd C. Breathlessness in cancer and chronic obstructive pulmonary disease: using a qualitative approach to describe the experience of patients and carers. Palliative & Supportive Care 2003, 1:337-344.
14. Booth S., Dudgeon D. Dyspnoea in Advanced Disease - A Guide to Clinical Management 2006, Oxford University Press, Oxford.
15. Booth, S., 2008 Improving the palliative care pf patients with intractable breathlessness, PhD, University of London.
16. Booth S., Moosavi S.H., Higginson I.J. The etiology and management of intractable breathlessness in patients with advanced cancer: a systematic review of pharmacological therapy. Nature Clinical Practice Oncology 2008, 5:90-100.
17. Booth S. Using hypnosis in palliative care: a clinician's experience. European Journal of Palliative Care 2009, 16:72-75.
18. Booth, S., Moffat, C., Farquhar, M., Higginson, I.J., Bausewein, C., Burkin, J., 2011. Developing a breathlessness service for patients with palliative and supportive care, irrespective of diagnosis, J Palliat Care 27(1), forthcoming.
19. Bredin M., Corner J., Krishnasamy M., Plant H., Bailey C., A'Hern R. Multicentre randomised controlled trial of nursing intervention for breathlessness in patients with lung cancer. British Medical Journal 1999, 318:901-904.
20. Cherny N.I., Portenoy R.K. Sedation in the management of refractory symptoms: guidelines for evaluation and treatment. Journal of Palliative Care 1994, 10:31-38.
21. Corner J., Plant H., A'Hern R., Bailey C. Non-pharmacological intervention for breathlessness in lung cancer. Palliative Medicine 1996, 10:299-305.
22. Cranston J.M., Crockett A., Currow D. Oxygen therapy for dyspnoea in adults. Cochrane Database of Systematic Reviews 2008, (3). Art. No: CD004769, CD004769.pub2. 10.1002/14651858.
23. Edmonds P., Karlsen S., Khan S., Addington-Hall J. A comparison of the palliative care needs of patients dying from chronic respiratory diseases and lung cancer. Palliative Medicine 2001, 15:87-295.
24. Escalante C.P., Martin C.G., Elting L.S., Price K.J., Manzullo E.F., Weiser M.A., Harle T.S., Cantor S.B., Rubenstein E.B. Identifying risk factors for imminent death in cancer patients with acute dyspnea. Journal of Pain and Symptom Management 2000, 20:318-325.
25. Escalante C.P., Manzullo E.F., Lam T.P., Ensor J.E., Valdres R.U., Wang X.S. Fatigue and its risk factors in cancer patients who seek emergency care. Journal of Pain and Symptom Management 2008, 36:358-366.
26. Galbraith S., Fagan P., Perkins P., Lynch A., Booth S. Does the use of a handheld fan improve chronic dyspnea? a randomized, controlled, crossover trial. Journal of Pain and Symptom Management 2010, 39:831-838.
27. Glennon C., Seskevich J. Relaxation technique to ease dyspnea: a tool for oncology nurses. Clinical Journal of Oncology Nursing 2008, 12:369-371.
28. Gray E., Booth S., Brage S., Yorke J., Moosavi S., Bausewein C., Molassiotis A., Johnson M., Farquhar C. Breathlessness research interest group - meeting report. Progress in Palliative Care 2010, 18:95-98. (December 2008 meeting), (accessed June 2010).
29. Gysels M.H., Higginson I.J. Caring for a person in advanced illness and suffering from breathlessness at home: threats and resources. Palliative & Supportive Care 2009, 7:153-162.
30. Hately J., Laurence V., Scott A., Baker R., Thomas P. Breathlessness clinics within specialist palliative care settings can improve the quality of life and functional capacity of patients with lung cancer. Palliative Medicine 2003, 17:410-417.
31. Henoch I., Bergman B., Danielson E. Dyspnoea experience and management strategies in patients with lung cancer. Psycho-Oncology 2008, 17:709-715.
32. Higginson I., McCarthy M. Measuring symptoms in terminal cancer: are pain and dyspnoea controlled?. Journal of the Royal Society of Medicine 1989, 82:264-267.
33. Hoekstra J., Vernooij-Dassen M.J.F.J., de Vos R., Bindels P.J.E. The added value of assessing the 'most troublesome' symptom among patients with cancer in the palliative phase. Patient Education and Counseling 2007, 65:223-229.
34. Hui, D., 2010 A randomised trial of bilevel positive pressure airway device and high flow oxygen for persistent dyspnoea in advanced cancer patients, Thesis dissertation presented for the degree of Master of Science, University of Texas.
35. Janson-Bjerklie S., Carrieri V.K., Hudes M. The sensations of pulmonary dyspnea. Nursing Research 1986, 35:154-159.
36. Jennings A.L., Davies A.N., Higgins J.P., Broadley K. Opioids for the palliation of breathlessness in terminal illness. Cochrane Database of Systematic Reviews 2001, (3). Art. No.: CD002066, CD002066. 10.1002/14651858.
37. Jennings A.L., Davies A.N., Higgins J.P.T., Gibbs J.S.R., Broadley K.E. A systematic review of the use of opioids in the management of dyspnoea. Thorax 2002, 57:939-944.
38. Jones A.L., Cameron I.R. The effect of promethazine and diazepam on respiratory control in breathless patients [abstract]. Clinical Science 1985, 185:69.
39. Light R.W., Stansbury D.W., Webster J.S. Effect of 30mg of morphine alone or with promethazine or prochlorperazine on the exercise capacity of patients with COPD. Chest 1996, 109:975-981.
40. Maltoni M., Caraceni A., Brunelli C., Broeckaert B., Christakis N., Eychmueller S., Glare P., Nabal M., Vigano A., Larkin P., De Conno F., Hanks G., Kaasa S. Prognostic factors in advanced cancer patients: evidence-based clinical recommendations - a study by the steering committee of the European association for palliative care. Journal of Clinical Oncology 2005, 23:6240-6248.
41. Man W.D., Kemp P., Moxham J., Polkey M.I. Exercise and muscle dysfunction in COPD: implications for pulmonary rehabilitation. Clinical Science (London) 2009, 117:281-291.
42. McDaniel R.W., Rhodes V.A. Symptom experience. Seminars in Oncology Nursing 1995, 11:232-234.
43. McIver B., Walsh D., Nelson K. The use of chlorpromazine for symptom control in dying cancer patients. Journal of Pain and Symptom Management 1994, 9:341-345.
44. A Framework for Development and Evaluation of RCTs for Complex Interventions to Improve Health 2000, Medical Research Council, Available from(accessed 10.06.10). http://www.mrc.ac.uk/Utilities/Documentrecord/index.htm?d=MRC003372.
45. Mercadante S., Intravaia G., Villari P., Ferrera P., David F., Casuccio A. Controlled sedation for refractory symptoms in dying patients. Journal of Pain and Symptom Management 2009, 37:771-779.
46. Moosavi S.H., Booth S. Pathophysiology of breathlessness. The Cambridge Breathlessness Manual 2011, Cambridge Breathlessness Group. (Self publisher). Cambridge University Hospital NHS Trust, Cambridge, (in press). S. Booth, C. Moffat, J. Burkin (Eds.).
47. Morris G.S., Gallagher G.H., Baxter M.F., Brueilly K.E., Scheetz J.S., Ahmed M.M., Shannon V.R. Pulmonary rehabilitation improves functional status in oncology patients. Archives of Physical Medicine and Rehabilitation 2009, 90:837-841.
48. Neuenschwander H., Molto A., Bianchi M. External nasal dilator strips (ENDS) may improve breathlessness in cancer patients. Supportive Care in Cancer 2006, 14:386-388.
49. O'Driscoll M., Corner J., Bailey C. The experience of breathlessness in lung cancer. European Journal of Cancer Care 1999, 8:37-43.
50. Polkey M., Moxham J. Attacking the disease spiral in chronic obstructive pulmonary disease. Clinical Medicine 2006, 6:190-196.
51. Reddy S.K., Parsons H.A., Elsayem A., Palmer J.L., Bruera E. Characteristics and correlates of dyspnea in patients with advanced cancer. Journal of Palliative Medicine 2009, 12:29-36.
52. Renfroe K.L. Effect of progressive relaxation on dyspnea and state anxiety in patients with chronic obstructive pulmonary disease. Heart Lung 1988, 17:408-413.
53. Rice K.L., Kronenberg R.S., Hedemark L.L., Niewoehner D.E. Effects of chronic administration of codeine and promethazine on breathlessness and exercise tolerance in patients with chronic airflow obstruction. British Journal of Diseases of the Chest 1987, 81:287-292.
54. Rocker G., Horton R., Currow D., Goodridge D., Young J., Booth S. Palliation of dyspnoea in advanced COPD: revisiting a role for opioids. Thorax 2009, 64:910-915.
55. Schwartzstein R.M., Lahive K., Pope A., Weinberger S.E., Weiss J.W. Cold facial stimulation reduces breathlessness induced in normal subjects. American Review of Respiratory Disease 1987, 136:58-61.
56. Shimoyama N., Shimoyama M. Nebulized furosemide as a novel treatment for dyspnea in terminal cancer patients. Journal of Pain and Symptom Management 2002, 23:73-76.
57. Simon S.T., Bausewein C. Management of refractory breathlessness in patients with advanced cancer. Wiener Medizinische Wochenschrift 2009, 159:591-598.
58. Simon S.T., Higginson I.J., Booth S., Harding R., Bausewein C. Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases in adults. Cochrane Database of Systematic Reviews 2010, (1). Art. No.: CD007354, CD007354.pub2. 10.1002/14651858.
59. Stark R.D., Gambles S.A., Lewis J.A. Methods to assess breathlessness in healthy subjects: a critical evaluation and application to analyse the acute effects of diazepam and promethazine on breathlessness induced by exercise or by exposure to raised levels of carbon dioxide. Clinical Science (London) 1981, 61:429-439.
60. Stone P., Hardy J., Broadley K., Tookman A.J., Kurowska A., A'Hern R. Fatigue in advanced cancer: a prospective controlled cross-sectional study. British Journal of Cancer 1999, 79:1479-1486.
61. Stone P., Richards M., A'Hern R., Hardy J. A study to investigate the prevalence, severity and correlates of fatigue among patients with cancer in comparison with a control group of volunteers without cancer. Annals of Oncology 2000, 11:561-567.
62. Tanaka K., Akechi T., Okuyama T., Nishiwaki Y., Uchitomi Y. Development and validation of the cancer dyspnoea scale: a multidimensional, brief, self-rating scale. British Journal of Cancer 2000, 82:800-805.
63. Twycross R., Wilcock A. Palliative Care Formulary 2007, Nottingham: Available from. http://www.palliativedrugs.com, third ed.
64. Vigano A., Dorgan M., Buckingham J., Bruera E., Suarez-Almazor M.E. Survival prediction in terminal cancer patients: a systematic review of the medical literature. Palliative Medicine 2000, 14:363-374.
65. Wenzel J. Results of a home-based walking intervention for patients undergoing cancer treatment March 7-11 2010, 16th International Conference on Cancer Nursing, International Society of Nurses in Cancer Care (ISNCC), Georgia USA, Abstract available from, (p. 24; 0-36) (accessed 10.06.10). http://www.isncc.org/files/PDF/16th_ICCN_Abstract_Book.pdf.
66. Wilcock A., Corcoran R., Tattersfield A.E. Safety and efficacy of nebulised lignocaine in patients with cancer and breathlessness. Palliative Medicine 1994, 8:35-38.
67. Wilcock A., Walton A., Manderson C., Feathers L., Khoury B.E., Lewis M., Chauhan A., Howard P., Bell S., Frisby J., Tattersfield A. Randomised, placebo controlled trial of nebulised furosemide for breathlessness in patients with cancer. Thorax 2008, 63:872-875.
68. Woodcock A.A., Gross E.R., Geddes D.M. Drug treatment of breathlessness: contrasting effects of diazepam and promethazine in pink puffers. British Medical Journal (Clinical Research Ed.) 1981, 283:343-346.
69. Yorke J., Moosavi S.H., Shuldham C., Jones P.W. Quantification of dyspnoea using descriptors: development and initial testing of the dyspnoea-12. Thorax 2010, 65:21-26.