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Takemura N, Cheung DST, Fong DYT, Hui D, Lee AWM, Lam TC, Ho JCM, Kam TY, Chik JYK, Lin CC. Tai Chi and Aerobic Exercise on Cancer-Related Dyspnea in Advanced Lung Cancer Patients: A Randomized Clinical Trial. J Pain Symptom Manage 2024:S0885-3924(24)00745-0. [PMID: 38729532 DOI: 10.1016/j.jpainsymman.2024.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/23/2024] [Accepted: 04/26/2024] [Indexed: 05/12/2024]
Abstract
CONTEXT Dyspnea, a prevalent and debilitating symptom in patients with advanced lung cancer, negatively affects symptom burden and prognosis. Physical activity has emerged as a promising non-pharmacological intervention for managing dyspnea. OBJECTIVES This study compared the effectiveness of two widely-recognized physical activity modalities, namely Tai Chi (TC) and aerobic exercise (AE) for treating dyspnea in patients with advanced lung cancer. METHODS Patients with advanced lung cancer (n=226) were randomized into TC, AE, or control groups. There was no baseline dyspnea requirement for patients. The AE group received two 60-minute supervised sessions and home-based exercises per month, the TC group received 60-minute sessions twice weekly, and the control group received exercise guidelines for 16 weeks. The primary outcome (sleep quality) of the study has been previously reported. In this secondary analysis, we focused on dyspnea outcomes, including overall and lung cancer-specific dyspnea. Assessments were conducted at baseline (T0), 16 weeks (T1), and one year (T2). RESULTS Compared to the control group, TC significantly improved overall dyspnea at T1 (between-group difference, -8.69; P=0.03) and T2 (between-group difference, -11.45; P=0.01), but not AE. Both AE (between-group difference, -11.04; P=0.01) and TC (between-group difference, -14.19; P<0.001) significantly alleviated lung cancer-specific dyspnea at T2 compared with the control group. CONCLUSION Both TC and AE alleviate dyspnea severity in patients with advanced lung cancer, and continuous exercise can yield substantial improvements. Due to its multi-component nature, Tai Chi has a greater effect on dyspnea.
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Affiliation(s)
- Naomi Takemura
- School of Nursing (N.T., D.S.T.C., D.Y.T.F., C.C.L.), Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Denise Shuk Ting Cheung
- School of Nursing (N.T., D.S.T.C., D.Y.T.F., C.C.L.), Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Daniel Yee Tak Fong
- School of Nursing (N.T., D.S.T.C., D.Y.T.F., C.C.L.), Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine (D.H.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anne Wing Mui Lee
- Department of Clinical Oncology (W.M.L., T.C.L.), The University of Hong Kong-Shenzhen Hospital, Guangdong, China; Department of Clinical Oncology (W.M.L., T.C.L.), Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Tai-Chung Lam
- Department of Clinical Oncology (W.M.L., T.C.L.), The University of Hong Kong-Shenzhen Hospital, Guangdong, China; Department of Clinical Oncology (W.M.L., T.C.L.), Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - James Chung-Man Ho
- Department of Medicine (J.C.M.H.), Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Tsz Yeung Kam
- Department of Clinical Oncology (T.Y.K.), Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Jeannie Yin Kwan Chik
- Department of Clinical Oncology (J.Y.K.C.), Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Chia-Chin Lin
- School of Nursing (N.T., D.S.T.C., D.Y.T.F., C.C.L.), Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong; Alice Ho Miu Ling Nethersole Charity Foundation Professor in Nursing (C.C.L.), Hong Kong.
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Llamas-Ramos I, Alvarado-Omenat JJ, Rodrigo-Reguilón M, Llamas-Ramos R. Quality of Life and Side Effects Management in Cancer Treatment-A Cross Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1708. [PMID: 36767073 PMCID: PMC9914572 DOI: 10.3390/ijerph20031708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/13/2023] [Accepted: 01/15/2023] [Indexed: 06/18/2023]
Abstract
Cancer disease is a world problem which is increasing in its prevalence. Oncology patients have a multitude of symptoms derived from the treatments and from the disease itself that affect their quality of life to a greater or lesser extent. The aim of this study has been to discover the physical and psychological symptoms related to chemotherapy treatment in Spanish cancer patients in order to improve their quality of life. Symptoms from the previous week were taken into account and the Memorial Symptom Assessment Scale was used to measure the frequency, severity and associated distress of 32 symptoms. A total of 246 chemotherapy patients at the University Day Hospital in Salamanca completed the scale once while receiving chemotherapy treatment. A 95% confidence interval was considered. The most prevalent symptoms were a lack of energy (76.4%), anxiety (66.7%) and a dry mouth (60.6%). Lung cancer was the most prevalent cancer in men (26%) and breast cancer was the most prevalent cancer in women (72%). There is no consensus on which is the most prevalent symptom in this population and more studies will need to be carried out to determine the best treatment protocols. Symptom's prevalence knowledge could improve the patients' care to prevent or avoid complications and to improve the cancer patients' quality of life.
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Affiliation(s)
- Inés Llamas-Ramos
- Faculty of Nursing and Physiotherapy, Universidad de Salamanca, C/Donantes de Sangre s/n, 37007 Salamanca, Spain
- University Hospital of Salamanca, Paseo de San Vicente, 182, 37007 Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
| | | | | | - Rocío Llamas-Ramos
- Faculty of Nursing and Physiotherapy, Universidad de Salamanca, C/Donantes de Sangre s/n, 37007 Salamanca, Spain
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Hackner K, Heim M, Masel EK, Riedl G, Weber M, Strieder M, Danninger S, Pecherstorfer M, Kreye G. Evaluation of diagnostic and treatment approaches to acute dyspnea in a palliative care setting among medical doctors with different educational levels. Support Care Cancer 2022; 30:5759-5768. [PMID: 35338391 PMCID: PMC9135814 DOI: 10.1007/s00520-022-06996-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/17/2022] [Indexed: 11/24/2022]
Abstract
Background Dyspnea is common in patients with advanced cancer. Diagnostic procedures in patients with dyspnea are mandatory but often time-consuming and hamper rapid treatment of the underlying refractory symptoms. Opioids are the first-line drugs for the treatment of refractory dyspnea in palliative care patients with advanced lung cancer. Methods To evaluate the knowledge levels of medical doctors with different educational levels on the diagnosis of and treatment options for dyspnea in patients with advanced lung cancer in a palliative care setting, a case report and survey were distributed to physicians at the University Hospital Krems, describing acute dyspnea in a 64-year-old stage IV lung cancer patient. A total of 18 diagnostic and 22 therapeutic options were included in the survey. The physicians were asked to suggest and rank in order of preference their diagnosis and treatment options. Statistical analyses of the data were performed, including comparison of the responses of the senior doctors and the physicians in training. Results A total of 106 surveys were completed. The respondents were 82 senior physicians and 24 physicians in training (response rates of 86% and 80%, respectively). Regarding diagnostic investigations, inspection and reading the patient’s chart were the most important diagnostic tools chosen by the respondents. The choices of performing blood gas analysis (p = 0.01) and measurement of oxygen saturation (p = 0.048) revealed a significant difference between the groups, both investigations performed more frequently by the physicians in training. As for non-pharmacological treatment options, providing psychological support was one of the most relevant options selected. A significant difference was seen in choosing the option of improving a patient’s position in relation to level of training (65.9% senior physicians vs. 30.4% physicians in training, p = 0.04). Regarding pharmacological treatment options, oxygen application was the most chosen approach. The second most frequent drug chosen was a ß-2 agonist. Only 9.8% of the senior physicians and 8.7% of the physicians in training suggested oral opioids as a treatment option, whereas intravenous opioids were suggested by 43.9% of the senior physicians and 21.7% of the physicians in training (p = 0.089). For subcutaneous application of opioids, the percentage of usage was significantly higher for the physicians in training than for the senior physicians (78.3% vs. 48.8%, p = 0.017, respectively). Conclusion The gold standard treatment for treating refractory dyspnea in patients with advanced lung cancer is opioids. Nevertheless, this pharmacological treatment option was not ranked as the most important. Discussing hypothetical cases of patients with advanced lung cancer and refractory dyspnea with experienced doctors as well as doctors at the beginning of their training may help improve symptom control for these patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-06996-6.
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Affiliation(s)
- Klaus Hackner
- Karl Landsteiner University of Health Sciences, Krems, Austria.,Department of Pneumology, University Hospital Krems, Krems, Austria
| | - Magdalena Heim
- Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Eva Katharina Masel
- Clinical Division of Palliative Medicine, Department of Internal Medicine I, Medical University Vienna, Vienna, Austria
| | - Gunther Riedl
- Department for Anesthesia and Intensive Care, Landesklinikum Baden-Mödling, Baden, Austria
| | - Michael Weber
- Karl Landsteiner University of Health Sciences, Krems, Austria
| | | | - Sandra Danninger
- Clinical Division of Palliative Medicine, Department of Internal Medicine II, University Hospital Krems, Mitterweg 10, 3500, Krems, Austria
| | - Martin Pecherstorfer
- Karl Landsteiner University of Health Sciences, Krems, Austria.,Clinical Division of Palliative Medicine, Department of Internal Medicine II, University Hospital Krems, Mitterweg 10, 3500, Krems, Austria
| | - Gudrun Kreye
- Karl Landsteiner University of Health Sciences, Krems, Austria. .,Clinical Division of Palliative Medicine, Department of Internal Medicine II, University Hospital Krems, Mitterweg 10, 3500, Krems, Austria.
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Fahy BN. Current Guidelines for Integration of Palliative Care in Oncology. Surg Oncol Clin N Am 2021; 30:431-447. [PMID: 34053660 DOI: 10.1016/j.soc.2021.02.002] [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] [Indexed: 11/18/2022]
Abstract
Multiple cancer societies and professional medical organizations recommend integration of palliative care into routine oncology care. A growing body of literature supports the benefits of palliative care in patients with cancer. Palliative care improves pain and other symptoms, enhances quality of life, and reduces depression. The best method and timing for integration of palliative care is unclear. Multiple barriers exist that prevent optimal palliative care integration; these barriers will require additional education and research to overcome.
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Affiliation(s)
- Bridget N Fahy
- Department of Surgery, Division of Surgical Oncology, University of New Mexico, 1 University of New Mexico, MSC 07-4025, Albuquerque, NM 87131, USA; Division of Palliative Medicine, University of New Mexico, Albuquerque, NM, USA.
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5
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Hallowell RW, Schwartzstein R, O'Donnell CR, Sheridan A, Banzett RB. Controlled Delivery of 80 mg Aerosol Furosemide Does Not Achieve Consistent Dyspnea Relief in Patients. Lung 2020; 198:113-120. [PMID: 31728632 PMCID: PMC11001166 DOI: 10.1007/s00408-019-00292-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 11/03/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE Aerosol furosemide may be an option to treat refractory dyspnea, though doses, methods of delivery, and outcomes have been variable. We hypothesized that controlled delivery of high dose aerosol furosemide would reduce variability of dyspnea relief in patients with underlying pulmonary disease. METHODS Seventeen patients with chronic exertional dyspnea were recruited. Patients rated recently recalled breathing discomfort on a numerical rating scale (NRS) and the multidimensional dyspnea profile (MDP). They then performed graded exercise using an arm-ergometer. The NRS was completed following each exercise grade, and the MDP was repeated after a pre-defined dyspnea threshold was reached. During separate visits, patients received either aerosol saline or 80 mg of aerosol furosemide in a randomized, double-blind, crossover design. After treatment, graded exercise to the pre-treatment level was repeated, followed by completion of the NRS and MDP. Treatment effect was defined as the difference between pre- and post-treatment NRS at end exercise, expressed in absolute terms as % Full Scale. "Responders" were defined as those showing treatment effect ≥ 20% of full scale. RESULTS Final analysis included 15 patients. Neither treatment produced a statistically significant change in NRS and there was no significant difference between treatments (p = 0.45). There were four "responders" and one patient whose dyspnea worsened with furosemide; two patients were responders with saline, of whom one also responded to furosemide. No adverse events were reported. CONCLUSIONS High dose controlled delivery aerosol furosemide was not statistically different from saline placebo at reducing exercise-induced dyspnea. However, a clinically meaningful improvement was noted in some patients.
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Affiliation(s)
- Robert W Hallowell
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Richard Schwartzstein
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
- Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Carl R O'Donnell
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
- Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Andrew Sheridan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Robert B Banzett
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA.
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Affiliation(s)
- Deborah Dudgeon
- Palliative Care, St. Boniface General Hospital, Winnipeg, Manitoba, Canada
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Cherny NI, Portenoy RK. Sedation in the Management of Refractory Symptoms: Guidelines for Evaluation and Treatment. J Palliat Care 2019. [DOI: 10.1177/082585979401000207] [Citation(s) in RCA: 292] [Impact Index Per Article: 58.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nathan I. Cherny
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Russell K. Portenoy
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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8
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Cherny NI, Coyle N, Foley KM. Suffering in the Advanced Cancer Patient: A Definition and Taxonomy. J Palliat Care 2019. [DOI: 10.1177/082585979401000211] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Nathan I. Cherny
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Nessa Coyle
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Kathleen M. Foley
- Department of Neurology, Memorial Sloan-Kettering Cancer Center and Department of Neurology, Cornell University Medical College, New York, New York, USA
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9
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Affiliation(s)
- Franco De Conno
- Division of Pain Therapy and Palliative Care, National Cancer Institute, Milan, Italy
| | - Luigi Saita
- Division of Pain Therapy and Palliative Care, National Cancer Institute, Milan, Italy
| | - Carla Ripamonti
- Division of Pain Therapy and Palliative Care, National Cancer Institute, Milan, Italy
| | - Vittorio Ventafridda
- Division of Pain Therapy and Palliative Care, National Cancer Institute, Milan, Italy
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10
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Dudgeon DJ, Harlos M, Clinch JJ. The Edmonton Symptom Assessment Scale (ESAS) as an Audit Tool. J Palliat Care 2019. [DOI: 10.1177/082585979901500304] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Michael Harlos
- Department of Family Medicine, University of Manitoba, St. Boniface General Hospital Palliative Care Unit, Winnipeg, Manitoba
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11
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Turner K, Chye R, Aggarwal G, Philip J, Skeels A, Lickiss JN. Dignity in Dying: A Preliminary Study of Patients in the Last Three Days of Life. J Palliat Care 2019. [DOI: 10.1177/082585979601200203] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The final three days of life of 50 consecutive patients on a busy integrated palliative care service is described, with regard to final cause of death, symptom control, drug prescription, retention of personal function, and other measures possibly relevant to dignity in dying. Good symptom relief was maintained without rapid or high escalation of doses of morphine or sedatives. Personal function was maintained in at least a moderate degree in the majority of patients. This study also illustrates some of the difficulties in describing and evaluating the concept of “dying with dignity”.
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Affiliation(s)
- Kristen Turner
- Sydney Institute of Palliative Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales
| | - Richard Chye
- Palliative Medicine Specialist, Prince of Wales Hospital, Randwick, New South Wales
| | - Ghauri Aggarwal
- Palliative Medicine Specialist, Concord Hospital, New South Wales
| | - Jennifer Philip
- Palliative Care Clinician, Alfred Hospital, Monash University, Pahran, Victoria
| | - Andrew Skeels
- Director of Hospice, Ann Caudle Centre, Bendigo, Victoria
| | - J. Norelle Lickiss
- Director of Palliative Care, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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Fainsinger R, Miller MJ, Bruera E, Hanson J, Maceachern T. Symptom Control during the Last Week of Life on a Palliative Care Unit. J Palliat Care 2019. [DOI: 10.1177/082585979100700102] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Robin Fainsinger
- Palliative Care Program, Edmonton General Hospital, Edmonton, Alberta, Canada
| | - Melvin J. Miller
- Palliative Care Program, Edmonton General Hospital, Edmonton, Alberta, Canada
| | - Eduardo Bruera
- Palliative Care Program, Edmonton General Hospital, Edmonton, Alberta, Canada
| | - John Hanson
- Department of Medicine and Epidemiology, Edmonton, Alberta, Canada
| | - Tara Maceachern
- Department of Medicine, Cross Cancer Institute, Edmonton, Alberta, Canada
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Booth S, Moffat C, Farquhar M, Higginson IJ, Burkin J. Developing A Breathlessness Intervention Service for Patients with Palliative and Supportive Care Needs, irrespective of Diagnosis. J Palliat Care 2018. [DOI: 10.1177/082585971102700106] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Sara Booth
- S Booth (corresponding author) University of Cambridge, Cambridge, UK, Department of Palliative Care and Policy, King's College, London, UK, and Addenbrookes Palliative Care Team, Elsworth House, Box 63, Hills Road, Cambridge, UK CB2
| | | | - Morag Farquhar
- General Practice and Primary Care Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Irene J. Higginson
- Department of Palliative Care, Policy, and Rehabilitation, Cicely Saunders Institute, London, UK
| | - Julie Burkin
- Addenbrookes Palliative Care Team, Cambridge, UK
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15
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Affiliation(s)
- Sara Booth
- St Nicholas Hospice, Bury St Edmunds IP33 2QY, UK.
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Iwase S, Murakami T, Saito Y, Nakagawa K. Preliminary Statistical Assessment of Intervention by a Palliative Care Team Working in a Japanese General Inpatient Unit. Am J Hosp Palliat Care 2016; 24:29-35. [PMID: 17347502 DOI: 10.1177/1049909106295302] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The effectiveness of intervention by the palliative care team at the University of Tokyo Hospital was assessed using the Support Team Assessment Schedule. During the study, 316 consecutive patients with malignant tumor disease were referred to the palliative care team, which assessed 11 physical symptoms. Results were tested by paired t test to calculate 95% confidence intervals comparing the mean Support Team Assessment Schedule scores for each symptom from the first time to the last time after palliative care intervention. The study concluded that (1) intervention by a palliative care team in general inpatient units can effectively control pain, nausea, and vomiting in patients up until the terminal stage; (2) it is likely that cough is controllable in the terminal stage with intervention by a palliative care team; (3) mouth dryness, anorexia, constipation, diarrhea, fatigue, and ascites are difficult to alleviate in the long term even with palliative intervention.
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Affiliation(s)
- Satoru Iwase
- Department of Palliative Medicine, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
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Plant H, Bredin M, Krishnasamy M, Corner J. Working with resistance, tension and objectivity: Conducting a randomised controlled trial of a nursing intervention for breathlessness. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/136140960000500606] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is vital that nurses wishing to recommend or introduce new strategies are able to provide supporting evidence that is acceptable to their colleagues. The methodology from which to derive such evidence remains to be clearly defined, as the research process is complex, demanding and, to a certain extent, uncharted. This paper examines the experience of nurses collaborating in a multi-centre randomised controlled trial which evaluated a nursing intervention for the management of breathlessness in patients with lung cancer. The study raised several important methodological issues: resistance among colleagues to innovative nursing practice; the difficulty of measuring well-being in patients whose physical condition is deteriorating; maintaining uniformity of practice within a diverse group of collaborating nurse researchers; and the tension between the nursing role and the necessity of an ethically demanding research design. Analysis of the process of conducting a randomised controlled trial produced valuable insights which indicated the kind of support required to undertake research and successfully implement a new intervention into clinical practice. The study also highlighted the problems associated with asking ill people to complete standard measurement tools, particularly when such instruments might not be sensitive to the reality of the patient(s) problem, in this case, the experience of breathlessness.
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Affiliation(s)
- Hilary Plant
- Centre of Cancer and Palliative Care studies, Institute of Cancer Research, Royal Marsden NHS Trust, London
| | - Mary Bredin
- Centre of Cancer and Palliative Care studies, Macmillan practice Development unit, Institute of Cancer Research, Royal Marsden NHS Trust, London
| | - Meinir Krishnasamy
- Centre of Cancer and Palliative Care studies, Macmillan practice Development unit, Institute of Cancer Research, Royal Marsden NHS Trust, London
| | - Jessica Corner
- Centre of Cancer and Palliative Care studies, Institute of Cancer Research, Royal Marsden NHS Trust, London
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19
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Kako J, Sakai T. The study of recognition of non-pharmacological interventions provided by nurses of palliative care units for dyspnea in terminally ill cancer patients. ACTA ACUST UNITED AC 2014. [DOI: 10.2512/jspm.9.2_101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jun Kako
- School of Health Sciences and Nursing, Graduate School of Medicine The University of Tokyo
| | - Tomoko Sakai
- School of Health Sciences and Nursing, Graduate School of Medicine The University of Tokyo
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20
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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 2013. [DOI: 10.1179/096992607x236434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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RAO P, GRUBNIC S. Imaging in the breathless cancer patient. IMAGING 2013. [DOI: 10.1259/imaging.20120020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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22
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Ochi T, Nakahashi H, Nishikubo N, Takeuchi A, Sasaki T, Mori Y. Retrospective evaluation of morphine for dyspnea in terminal cancer patients. ACTA ACUST UNITED AC 2013. [DOI: 10.2512/jspm.8.334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Yorke J, Brettle A, Molassiotis A. Nonpharmacological interventions for managing respiratory symptoms in lung cancer. Chron Respir Dis 2012; 9:117-29. [PMID: 22452974 DOI: 10.1177/1479972312441632] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Patients with lung cancer experience significant symptom burden, particularly symptoms of a respiratory nature. Such symptom burden can be distressing for patients and negatively impact their functional status and quality of life. The aim of this review is to evaluate studies of nonpharmacological and noninvasive interventions for the management of respiratory symptoms experienced by patients with lung cancer. In total, 13 studies met the inclusion criteria for this review and included 1383 participants of which 1296 were lung cancer patients. The most frequently assessed and reported symptom was breathlessness (n = 9 studies). Cough and haemoptysis were reported in one study. A variety of outcome measurement tools were used and a broad range of intervention strategies evaluated. Lack of consistency between studies impinged on the ability to combine studies. It is not possible to draw any firm conclusion as to the effectiveness of nonpharmacological interventions for the management of respiratory symptoms in lung cancer. Nonpharmacological interventions may well have an important role to play in the management of some of the respiratory symptoms (or combinations of respiratory symptoms), but more work of higher quality is necessary in the future.
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Affiliation(s)
- Janelle Yorke
- School of Nursing, Midwifery and Social Work, University of Salford, Manchester, UK
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Pohl G, Marosi C, Dieckmann K, Goldner G, Elandt K, Hassler M, Schemper M, Strasser-Weippl K, Nauck F, Gaertner J, Watzke H. Evaluation of diagnostic and treatment approaches towards acute dyspnea in a palliative care setting among medical students at the University of Vienna. Wien Med Wochenschr 2012; 162:18-28. [DOI: 10.1007/s10354-011-0046-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 12/16/2011] [Indexed: 12/01/2022]
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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]
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Leppert W, Turska A, Majkowicz M, Dziegielewska S, Pankiewicz P, Mess E. Quality of Life in Patients With Advanced Lung Cancer Treated at Home and at a Palliative Care Unit. Am J Hosp Palliat Care 2011; 29:379-87. [DOI: 10.1177/1049909111426135] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: To assess quality of life (QOL) in patients with advanced lung cancer. Patients and Methods: A prospective study of 78 patients cared at home and at a palliative care unit (PCU) with 2 QOL assessments was conducted. Results: Fifty patients completed the study. In the EORTC QLQ-C30 role, cognitive, social functioning, global QOL, fatigue, pain, dyspnea, and appetite deteriorated; nausea/vomiting improved; dyspnea was more intense in the case of in-home patients. In the EORTC QLQ-LC13 hemoptysis improved; pain in other parts was more intense in the PCU patients. Pain (Visual Analogue scale) was more intense in the PCU patients; the level of activity (Karnofsky) decreased in the case of patients treated at home. Conclusions: QOL deteriorated with few differences between home and the PCU patients.
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Affiliation(s)
- Wojciech Leppert
- Chair and Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Turska
- Chair and Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Mikolaj Majkowicz
- Department of Quality of Life Research, Gdansk Medical University, Gdansk, Poland
| | | | - Piotr Pankiewicz
- Department of Psychiatry, Gdansk Medical University, Gdansk, Poland
| | - Eleonora Mess
- Palliative Care Nursing Department, Wroclaw University of Medical Sciences, Wroclaw, Poland
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Bausewein C, Le Grice C, Simon S, Higginson I. The use of two common palliative outcome measures in clinical care and research: a systematic review of POS and STAS. Palliat Med 2011; 25:304-13. [PMID: 21464119 DOI: 10.1177/0269216310395984] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The Palliative Care Outcome Scale (POS) and the Support Team Assessment Schedule (STAS) are outcome measures assessing quality of care in palliative care patients. This review aims to appraise their use in clinical care and research. Five electronic databases were searched (February 2010) for original papers describing the validation or use of POS and/or STAS. Of the 83 papers included, 43 studies were on POS, 39 on STAS and one study using both. Eight STAS studies validated the original version, four an adaptation; 20 studies applied the STAS in another culture and 19 in other languages. POS papers reported included: 14 adapted POS versions, 12 translations of the POS and 15 studies of use in different cultures. Both measures have been used in cancer, HIV/AIDS and in mixed groups. POS has also been applied in neurological, kidney, pulmonary and heart disease. Both tools were used in different areas such as the evaluation of care or interventions, description of symptom prevalence and implementation of outcome measures in clinical practice. Overall, they seem to be well accepted tools for outcome measurement in palliative care, both in clinical care and research.
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Affiliation(s)
- C Bausewein
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK.
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Study protocol: Phase III single-blinded fast-track pragmatic randomised controlled trial of a complex intervention for breathlessness in advanced disease. Trials 2011; 12:130. [PMID: 21599896 PMCID: PMC3114770 DOI: 10.1186/1745-6215-12-130] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 05/20/2011] [Indexed: 11/16/2022] Open
Abstract
Background Breathlessness in advanced disease causes significant distress to patients and carers and presents management challenges to health care professionals. The Breathlessness Intervention Service (BIS) seeks to improve the care of breathless patients with advanced disease (regardless of cause) through the use of evidence-based practice and working with other healthcare providers. BIS delivers a complex intervention (of non-pharmacological and pharmacological treatments) via a multi-professional team. BIS is being continuously developed and its impact evaluated using the MRC's framework for complex interventions (PreClinical, Phase I and Phase II completed). This paper presents the protocol for Phase III. Methods/Design Phase III comprises a pragmatic, fast-track, single-blind randomised controlled trial of BIS versus standard care. Due to differing disease trajectories, the service uses two broad service models: one for patients with malignant disease (intervention delivered over two weeks) and one for patients with non-malignant disease (intervention delivered over four weeks). The Phase III trial therefore consists of two sub-protocols: one for patients with malignant conditions (four week protocol) and one for patients with non-malignant conditions (eight week protocol). Mixed method interviews are conducted with patients and their lay carers at three to five measurement points depending on randomisation and sub-protocol. Qualitative interviews are conducted with referring and non-referring health care professionals (malignant disease protocol only). The primary outcome measure is 'patient distress due to breathlessness' measured on a numerical rating scale (0-10). The trial includes economic evaluation. Analysis will be on an intention to treat basis. Discussion This is the first evaluation of a breathlessness intervention for advanced disease to have followed the MRC framework and one of the first palliative care trials to use fast track methodology and single-blinding. The results will provide evidence of the clinical and cost-effectiveness of the service, informing its longer term development and implementation of the model in other centres nationally and internationally. It adds to methodological developments in palliative care research where complex interventions are common but evidence sparse. Trial Registration ClinicalTrials.gov: NCT00678405 ISRCTN: ISRCTN04119516
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Cronin KA, Twomey M, O'Reilly M, Carney DN. An unusual case of dyspnea in metastatic breast carcinoma. J Pain Symptom Manage 2011; 41:e1-3. [PMID: 21227631 DOI: 10.1016/j.jpainsymman.2010.10.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 10/13/2010] [Indexed: 10/18/2022]
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Braiteh F, Bruera E. Palliative Care in the Management of Cancer Pain. Pain Manag 2011. [DOI: 10.1016/b978-1-4377-0721-2.00039-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Barton R, English A, Nabb S, Rigby AS, Johnson MJ. A randomised trial of high vs low intensity training in breathing techniques for breathless patients with malignant lung disease: A feasibility study. Lung Cancer 2010; 70:313-9. [DOI: 10.1016/j.lungcan.2010.03.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 03/06/2010] [Accepted: 03/13/2010] [Indexed: 11/27/2022]
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What Is the Evidence That Palliative Care Teams Improve Outcomes for Cancer Patients and Their Families? Cancer J 2010; 16:423-35. [PMID: 20890138 DOI: 10.1097/ppo.0b013e3181f684e5] [Citation(s) in RCA: 271] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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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. J Pain Symptom Manage 2010; 39:831-8. [PMID: 20471544 DOI: 10.1016/j.jpainsymman.2009.09.024] [Citation(s) in RCA: 162] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 09/09/2009] [Accepted: 09/28/2009] [Indexed: 11/26/2022]
Abstract
CONTEXT Dyspnea is a disabling distressing symptom that is common in advanced disease affecting millions of people worldwide. Current palliative strategies are partially effective in managing this symptom; facial cooling has been shown to reduce the sensation of breathlessness when induced in volunteers but has not been formally investigated in dyspnea associated with disease. OBJECTIVE The objective of this study was to investigate whether a handheld fan reduces the sensation of breathlessness in such patients, enhancing palliative approaches. METHODS The effectiveness of a handheld fan (blowing air across the nose and mouth) in reducing the sensation of breathlessness was assessed in patients with advanced disease. Fifty participants were randomized to use a handheld fan for five minutes directed to their face or leg first and then crossed over to the other treatment. The primary outcome measure was a decrease of greater than 1cm in breathlessness recorded on a 10 cm visual analog scale (VAS). RESULTS There was a significant difference in the VAS scores between the two treatments, with a reduction in breathlessness when the fan was directed to the face (P=0.003). CONCLUSION This study supports the hypothesis that a handheld fan directed to the face reduces the sensation of breathlessness. The fan was acceptable to participants: it is inexpensive, portable, enhances self-efficacy, and available internationally. It should be recommended as part of a palliative management strategy for reducing breathlessness associated with advanced disease.
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Affiliation(s)
- Sarah Galbraith
- Palliative Care Service, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom.
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Gysels M, Higginson IJ. The experience of breathlessness: the social course of chronic obstructive pulmonary disease. J Pain Symptom Manage 2010; 39:555-63. [PMID: 20303029 DOI: 10.1016/j.jpainsymman.2009.08.009] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Revised: 08/13/2009] [Accepted: 08/29/2009] [Indexed: 11/16/2022]
Abstract
CONTEXT There is a trend toward extending palliative care to nonmalignant diseases. There is no evidence that chronic obstructive pulmonary disease (COPD) requires its own model. OBJECTIVES The aim of this study was to investigate how the experience of breathlessness in COPD influences patients' attitudes toward the end of life and their quality of life. METHODS Eighteen patients were purposively sampled. Data were collected through in-depth interviews and participant observation during outpatient consultations. Narrative methods were used to analyze the data. RESULTS Treatment-seeking in COPD deviated from prototypical trajectories. Contact with health care was postponed to crisis point. Treatment did not follow diagnosis because of how the diagnosis was given. Help was sought when the symptom had acquired meaning in a person's life. The future did not feature in the interviews. CONCLUSION Good communication practices are fundamental in the care for COPD patients. Particularly, diagnosis and prognosis need to be rethought in a model to suit the condition of COPD.
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Affiliation(s)
- Marjolein Gysels
- Palliative Care Policy & Rehabilitation, School of Medicine, King's College London, London, United Kingdom.
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35
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Pohl G, Gaertner J. Pathophysiology and diagnosis of dyspnea in patients with advanced cancer. Wien Med Wochenschr 2009; 159:571-6. [DOI: 10.1007/s10354-009-0725-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Accepted: 11/17/2009] [Indexed: 11/27/2022]
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Gysels MH, Higginson IJ. Self-management for breathlessness in COPD: the role of pulmonary rehabilitation. Chron Respir Dis 2009; 6:133-40. [DOI: 10.1177/1479972309102810] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Most of the effort of controlling breathlessness happens at home. Therefore, it is important to explore how patients and carers respond to breathlessness, what their self-care entails and what they experience as helpful. Data were collected from a purposive sample of 18 chronic obstructive pulmonary disease patients through participant observation during outpatient consultations and in-depth interviews at a large hospital and in the community in London. Data were analysed with the Grounded Theory approach. As information regarding the management of breathlessness was lacking and access to treatment was difficult, patients reverted to alternative strategies. Some patients developed considerable expertise and managed their symptoms competently within the limits of current care. Patients who coped successfully were involved in pulmonary rehabilitation and had adopted this as a way of life. Benefits and challenges to participation in these programmes were identified. Those patients who self-manage maintain an acceptable quality of life through self-acquired expertise relating to symptoms, medication and help-seeking. Well-being needs to be understood not as the end point, but as a precarious balance needing skilful maintenance and hard work. The findings have implications for notions such as adherence, patient involvement and responsibility in the management of chronic obstructive pulmonary disease.
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Affiliation(s)
- MH Gysels
- King’s College London, Department of Palliative Care, Policy & Rehabilitation School of Medicine, London, UK; Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - IJ Higginson
- King’s College London, Department of Palliative Care, Policy & Rehabilitation School of Medicine, London, UK
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37
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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: 91] [Impact Index Per Article: 6.1] [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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39
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Gysels M, Higginson IJ. Access to services for patients with chronic obstructive pulmonary disease: the invisibility of breathlessness. J Pain Symptom Manage 2008; 36:451-60. [PMID: 18495412 DOI: 10.1016/j.jpainsymman.2007.11.008] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Revised: 11/09/2007] [Accepted: 11/23/2007] [Indexed: 10/22/2022]
Abstract
The aim of this study was to explore the experience of breathlessness in patients with chronic obstructive pulmonary disease (COPD) through patients' accounts of their interactions with services. The study has a qualitative design based on Grounded Theory. Data were collected through semistructured, in-depth interviews over the period of July 2005 to March 2006. This was complemented by participant observation during outpatient consultations. NVivo software was used to manage and analyze the data. The study is part of a wider program, "Improving Breathlessness." Data were collected in a large inner city teaching hospital and the community in London. A purposive sample of 18 COPD patients was selected. Fourteen patients were recruited from outpatient clinics in the hospital, four patients via a family doctor's surgery. Patients with moderate or severe COPD, who were experiencing problems with breathlessness, were included. The results showed that the low access to services by COPD patients is due to the nature of breathlessness itself, with its slow and surreptitious onset; patient interactions with the social environment assigning stigma to breathlessness; and the way the symptom is addressed by institutions, such as health care services, which discredit the patient's experience. The concept that best captures the experience of breathlessness is "invisibility." Problems with access to care are an additional dimension of suffering added to the illness experience. A palliative care approach is promoted and essential priorities identified to reduce barriers to access.
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Affiliation(s)
- Marjolein Gysels
- King's College London, Department of Palliative Care, Policy and Rehabilitation, School of Medicine, London, United Kingdom.
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41
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Zhao I, Yates P. Non-pharmacological interventions for breathlessness management in patients with lung cancer: a systematic review. Palliat Med 2008; 22:693-701. [PMID: 18715967 DOI: 10.1177/0269216308095024] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim is to review the published scientific literature for studies evaluating non-pharmacological interventions for breathlessness management in patients with lung cancer. The following selection criteria were used to systematically search the literature: studies were to be published research or systematic reviews; they were to be published in English and from 1990 to 2007; the targeted populations were adult patients with dyspnoea/breathlessness associated with lung cancer; and the study reported on the outcomes from use of non-pharmacological strategies for breathlessness. This review retrieved five studies that met all inclusion criteria. All the studies reported the benefits of non-pharmacological interventions in improving breathlessness regardless of differences in clinical contexts, components of programmes and methods for delivery. Analysis of the available evidence suggests that tailored instructions delivered by nurses with sufficient training and supervision may have some benefits over other delivery approaches. Based on the results, non-pharmacological interventions are recommended as effective adjunctive strategies in managing breathlessness for patients with lung cancer. In order to refine such interventions, future research should seek to explore the core components of such approaches that are critical to achieving optimal outcomes, the contexts in which the interventions are most effective, and to evaluate the relative benefits of different methods for delivering such interventions.
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Affiliation(s)
- I Zhao
- Institute of Health and Biomedical Innovation, School of Nursing, Queensland University of Technology, Queensland, Australia
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Use of oxygen and opioids in the palliation of dyspnoea in hypoxic and non-hypoxic palliative care patients: a prospective study. Support Care Cancer 2008; 17:367-77. [DOI: 10.1007/s00520-008-0479-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Accepted: 06/25/2008] [Indexed: 11/27/2022]
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Brundage M, Bezjak A, Tu D, Palmer M, Pater J. NCIC Clinical Trials Group experience of employing patient-reported outcomes in clinical trials: an illustrative study in a palliative setting. Expert Rev Pharmacoecon Outcomes Res 2008; 8:243-53. [PMID: 20528376 DOI: 10.1586/14737167.8.3.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In this article we briefly review the experience of the National Cancer Institute of Canada (NCIC) Clinical Trials Group (CTG) with respect to the assessment of patient reported outcomes in clinical trials, and illustrate issues important to assessing symptom palliation in clinical trials of cancer therapy. We highlight a standard approach taken by the NCIC CTG, and illustrate how this approach may be applied to the complex problem of symptom control analysis in patients with locally advanced NSCLC. We further illustrate how variations in this analysis yield different apparent rates of palliation. Apparent rates of palliation critically depended on the outcome measures used: single symptom response across patients (5-32%, depending on the symptom of interest), symptom response in specific symptomatic patients (37-100%), symptom control (45-82%), index symptom response (60%), proportion of patients experiencing improvement in all symptoms (21%), or health-related quality of life (HRQoL) improvement (23%, global). Rates also varied substantively depending on which cohort of patients was considered relevant to each analysis (i.e., was included in the respective denominator). Substantive discordance in patients' apparent palliation was seen when HRQoL data were compared with symptom diary data. Appropriate and valid descriptions of palliative outcomes in clinical trials are complex undertakings. We conclude that several measures are required for a textured clinical description of outcome, and recommend reporting palliation according to individual symptom response rates and HRQoL response rates, in order to address each construct of palliation success.
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Affiliation(s)
- Michael Brundage
- Division of Cancer Control and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, K7L 3N6, Canada.
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Hallenbeck J, Kauser F, LeGrand SB. Theophylline for Unexplained Dyspnea in Palliative Medicine: A Case Report. J Palliat Med 2008; 11:510-3. [DOI: 10.1089/jpm.2008.9950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Fariha Kauser
- The Section of Palliative Medicine and Supportive Care, The Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio
| | - Susan B. LeGrand
- The Section of Palliative Medicine and Supportive Care, The Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio
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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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Clemens KE, Quednau I, Klaschik E. Is There a Higher Risk of Respiratory Depression in Opioid-Naïve Palliative Care Patients during Symptomatic Therapy of Dyspnea with Strong Opioids? J Palliat Med 2008; 11:204-16. [DOI: 10.1089/jpm.2007.0131] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Katri Elina Clemens
- Department of Science and Research for Palliative Medicine, University of Bonn, Bonn, Germany
| | - Ines Quednau
- Department of Science and Research, Center for Palliative Medicine, Bonn, Germany
| | - Eberhard Klaschik
- Department of Science and Research, Center for Palliative Medicine, Bonn, Germany
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van den Beuken-van Everdingen MHJ, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J. High prevalence of pain in patients with cancer in a large population-based study in The Netherlands. Pain 2007; 132:312-320. [PMID: 17916403 DOI: 10.1016/j.pain.2007.08.022] [Citation(s) in RCA: 188] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Revised: 06/26/2007] [Accepted: 08/20/2007] [Indexed: 12/19/2022]
Abstract
UNLABELLED At present, no definite conclusions can be drawn about the real extent of the pain suffered by cancer patients. A population-based study was conducted to obtain reliable information about the prevalence and severity of pain in cancer patients (all phases) and about predictors of pain. A representative sample of cancer patients was recruited in the area from a cancer registry. Pain was assessed by the Brief Pain Inventory (BPI). Adequacy of pain treatment was assessed with the Pain Management Index (PMI). We found that 55% of the 1429 respondents had experienced pain past week; in 44% (n=351), the pain was moderate to severe (BPI score>or= 4). Total prevalence of pain/moderate to severe pain was present in 49%/41% in patients with curative treatment >or=6 months ago, 57%/43% in patients with current curative treatment or treatment <6 months ago, 56%/43% in patients with current palliative anti-cancer treatment and in 75%/70% in patients for whom treatment was no longer feasible. Positive predictors of the prevalence of pain were lower education level, more advanced disease and haematological (excluding (non)-Hodgkin lymphoma), gastro-intestinal, lung, or breast malignancies. According to the PMI, analgesic treatment was inadequate in 42% of the patients. Negative predictors of adequate treatment were current curative anti-cancer treatment and low education level. CONCLUSION A substantial proportion of cancer patients does suffer from moderate to severe pain and does not receive adequate pain treatment.
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Affiliation(s)
- Marieke H J van den Beuken-van Everdingen
- University Hospital Maastricht, Pain Management and Research Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands University Hospital Maastricht, Department of Clinical Epidemiology and Medical Technology Assessment, The Netherlands University Hospital Maastricht, Department of Internal Medicine, The Netherlands University Hospital Maastricht, Department of Anaesthesiology, The Netherlands
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Clemens KE, Klaschik E. Symptomatic therapy of dyspnea with strong opioids and its effect on ventilation in palliative care patients. J Pain Symptom Manage 2007; 33:473-81. [PMID: 17397708 DOI: 10.1016/j.jpainsymman.2006.09.015] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Revised: 09/04/2006] [Accepted: 09/06/2006] [Indexed: 11/30/2022]
Abstract
This study assessed the effect of opioid treatment on ventilation in dyspneic palliative care patients who received symptomatic treatment with strong opioids. The assessments measured changes in peripheral arterial oxygen saturation (SaO(2)), transcutaneous arterial pressure of carbon dioxide (tcPCO(2)), respiratory rate (f), and pulse rate (PF) during the titration phase with morphine or hydromorphone. The aims of the study were to verify the efficacy of opioids for the management of dyspnea, assess the effect on ventilation, and show whether nasal O(2) insufflation before opioid application leads to a decrease in the intensity of dyspnea. Eleven patients admitted to our palliative care unit were included in this prospective, nonrandomized trial. At admission, all patients suffered from dyspnea. tcPCO(2), SaO(2), and PF were measured transcutaneously by means of a SenTec Digital Monitor (SenTec AG, Switzerland). During O(2) insufflation, the intensity of dyspnea did not change. In contrast, the opioid produced a significant improvement in the intensity of dyspnea (P=0.003). Mean f decreased as early as 30 minutes after the first opioid administration, declining from 41.8+/-4.7 (35.0-50.0) to 35.5+/-4.2 (30.0-40.0), and after 90 minutes, to 25.7+/-4.5 (20.0-32.0) breaths/min. Other monitored respiratory parameters, however, showed no significant changes. There was no opioid-induced respiratory depression.
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Affiliation(s)
- Katri Elina Clemens
- Department of Science and Research in Palliative Medicine, University of Bonn, and Center for Palliative Medicine, Malteser Hospital Bonn/Rhein-Sieg Bonn, Germany.
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van den Beuken-van Everdingen MHJ, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J. Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol 2007; 18:1437-49. [PMID: 17355955 DOI: 10.1093/annonc/mdm056] [Citation(s) in RCA: 1193] [Impact Index Per Article: 70.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite the abundant literature on this topic, accurate prevalence estimates of pain in cancer patients are not available. We investigated the prevalence of pain in cancer patients according to the different disease stages and types of cancer. PATIENTS AND METHODS A systematic review of the literature was conducted. An instrument especially designed for judging prevalence studies on their methodological quality was used. Methodologically acceptable articles were used in the meta-analyses. RESULTS Fifty-two studies were used in the meta-analysis. Pooled prevalence rates of pain were calculated for four subgroups: (i) studies including patients after curative treatment, 33% [95% confidence interval (CI) 21% to 46%]; (ii) studies including patients under anticancer treatment: 59% (CI 44% to 73%); (iii) studies including patients characterised as advanced/metastatic/terminal disease, 64% (CI 58% to 69%) and (iii) studies including patients at all disease stages, 53% (CI 43% to 63%). Of the patients with pain more than one-third graded their pain as moderate or severe. Pooled prevalence of pain was >50% in all cancer types with the highest prevalence in head/neck cancer patients (70%; 95% CI 51% to 88%). CONCLUSION Despite the clear World Health Organisation recommendations, cancer pain still is a major problem.
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Braiteh F, Bruera E. Palliative Care in the Management of Cancer Pain. Pain Manag 2007. [DOI: 10.1016/b978-0-7216-0334-6.50039-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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