Development and validation of the Total Dyspnea Scale for Cancer Patients

Development and validation of a risk prediction model for community-acquired pressure injury in a cancer population: A case-control study

BACKGROUND

Patients with cancer are susceptible to pressure injuries, which accelerate deterioration and death. In patients with post-acute cancer, the risk of pressure injury is ignored in home or community settings.

OBJECTIVE

To develop and validate a community-acquired pressure injury risk prediction model for cancer patients.

METHODS

All research data were extracted from the hospital's electronic medical record system. The identification of optimal predictors is based on least absolute shrinkage and selection operator regression analysis combined with clinical judgment. The performance of the model was evaluated by drawing a receiver operating characteristic curve and calculating the area under the curve (AUC), calibration analysis and decision curve analysis. The model was used for internal and external validation, and was presented as a nomogram.

RESULTS

In total, 6257 participants were recruited for this study. Age, malnutrition, chronic respiratory failure, body mass index, and activities of daily living scores were identified as the final predictors. The AUC of the model in the training and validation set was 0.87 (95 % confidence interval [CI], 0.85-0.89), 0.88 (95 % CI, 0.85-0.91), respectively. The model demonstrated acceptable calibration and clinical benefits.

CONCLUSIONS

Comorbidities in patients with cancer are closely related to the etiology of pressure injury, and can be used to predict the risk of pressure injury.

IMPLICATIONS FOR PRACTICE

This study provides a tool to predict the risk of pressure injury for cancer patients. This suggests that improving the respiratory function and nutritional status of cancer patients may reduce the risk of community-acquired pressure injury.

Cancer-related breathlessness: opioids other than morphine - comprehensive literature review

INTRODUCTION

Although there is low-quality evidence, there has been an increase in publications on the experience of evaluating and managing cancer-related breathlessness using opioids other than morphine.

METHODS

The author conducted a non-systematic literature review in the PubMed/Medline and Embase until 4 October 2022. Eligible studies have evaluated the efficacy of opioids other than morphine for cancer-related breathlessness. Studies focused on sedation, anaesthesia, paediatric patients, opioid toxicity or basic research were excluded. Reviews/meta-analyses and non-English language publications were also excluded.

RESULTS

A total of 1556 records were identified, of which 23 studies including 469 patients who were treated with fentanyl (n=223), oxycodone (n=171) and hydromorphone (n=75) were considered eligible. Six phase II randomised clinical trials (RCTs), four observational studies and four case reports of fentanyl were found. For breathlessness on exertion, fentanyl yielded promising results, but no RCT showed significant superiority of fentanyl to placebo or morphine. For terminal breathlessness, three RCTs, five non-randomised or observational studies and one case report on oxycodone or hydromorphone were found. Although the results of the observational studies suggested that oxycodone and hydromorphone might be effective alternatives to morphine, the superiority over placebo or non-inferiority to morphine had not been demonstrated in the RCTs.

CONCLUSION

As an alternative to morphine, the author recommends fentanyl for breathless crisis or breathlessness on exertion, and oxycodone or hydromorphone for terminal breathlessness in advanced cancer. Larger and well-designed studies based on firm research policies are needed to confirm this current knowledge.

Dyspnea in Oncological Patients: a Brain Teaser

Dyspnea is one of the most common symptoms in oncological patients with greater prevalence in lung cancer and advanced disease states. Causes of dyspnea can be directly or indirectly associated with cancer, anti-neoplastic therapies and comorbidities unrelated to cancer. Routine screening of dyspnea is suggested for all oncological patients by using unidimensional, simple scales and multidimensional tools to capture more domains affected by this symptom and to assess the effectiveness of interventions. The first step in the treatment algorithm of dyspnea is the identification of potentially reversible causes; if no specific cause is depicted, symptomatic treatment with non-pharmacological and pharmacological interventions is suggested. Referral to palliative care and continuous palliative sedation are the last resort in patients with a very limited life expectancy of not more than a few days for symptomatic relief and to decrease of the distress of patients and caregivers.

Multi-Dimensional Dyspnea-Related Scales Validated in Individuals With Cardio-Respiratory and Cancer Diseases. A Systematic Review of Psychometric Properties

CONTEXT

In order to examine the multi-dimensional nature of dyspnea and its impact on the activities of daily living (ADLs) in patients with cardio-respiratory and cancer diseases, validated measures are needed.

OBJECTIVES

Our aim was to identify all the multi-dimensional clinical scales assessing dyspnea and its impact on ADLs in patients with cardio-respiratory and cancer diseases, and to critically appraise their psychometric properties.

METHODS

Five databases were systematically searched up to July 2020. Eligible criteria were: the examination of at least one psychometric property, and the recruitment of adults with a cardio-respiratory or cancer disease in non-emergency settings. The characteristics and psychometric properties of the studies included were presented through a narrative synthesis. The methodological quality of the studies and evidence synthesis were rated using the "COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN)" criteria.

RESULTS

Forty-three studies, for which eight assessment scales had been identified, were included in the review. At the time of the review, three multi-dimensional assessment scales were available for assessing dyspnea symptoms, and five multi-dimensional scales were available to examine the impact of dyspnea on ADLs. Although the use of these scales has rapidly grown, evidence of psychometric properties has been reported as limited in most of the scales.

CONCLUSION

Despite the potential of the identified scales, further studies are needed to strength evidence on the validity and reliability of the multi-dimensional dyspnea scales. Furthermore, more studies appraising the content validity and responsiveness of the scales are specifically recommended.

Significance of Dyspnoea as a symptom in the Emergency Department of the Primary Healthcare Centre

Background/Aim: Dyspnoea represents a subjective feeling of laboured breathing of different intensity. The aim of this study was to determine how often patients come with dyspnoea to a local Emergency Department of the Primary Healthcare Centre (EDPHC) and to analyse the assumed aetiology, diagnostics and therapy of the dyspnoeic patients. Methods: The records of the EDPHC of the City of Banja Luka for the period between 1 October 2019 to 31 December 2019 of all patients older than 15 years of age that have reported laboured breathing were identified and analysed. Following parameters were recorded: age, gender, diagnostics performed, administered therapy, whether the patient was examined in the field or in the ambulance, as well as whether the patient was referred to a hospital (Cardiology, Pulmonology or another department) or not. Results: Laboured breathing was reported by 665 patients. Out of this number, 108 patients were examined by their family doctor, 407 patients in EDPHC ambulance and 150 patients in the field. The average age of the patient was 61.03 ± 19.17, with an equal distribution in males and females. The aetiology of dyspnoea was cardiac and pulmonary in one-third of patients each, whereas the diagnosis in the other patients was versatile, from anxiety disorders, musculoskeletal diseases and active malignancy to unspecified chest pain that could not receive a definitive diagnosis. One half of the patients (N = 261 or 46.86 %) was completely taken care of in the ambulance or in the field, 199 (35.73 %) patients were sent to a cardiologist, 87 (15.62 %) to a pulmonologist and 10 (1.80 %) of patients to another specialist. Referral to hospital was registered more often in men (ch2 = 9.195, p = 0.027), elderly (ch2 = 53.29, p < 0.001), people with lower peripheral oxygen saturation (SpO2 ) (ch2 = 120.61, p < 0.001) and people with significant deviation of normal blood pressure values (ch2 = 120.61, p < 0.001). Conclusion: Dyspnoea can be caused by an array of different diseases and more than one diagnostic method is necessary to confirm/exclude any of the most common causes of dyspnoea. A broader diagnostical palette in ED would be preferred for purposes of ascertaining a timely diagnosis.