ABSTRACT
Background: Episodic dyspnea (ED) is a common problem in patients with advanced lung cancer (LC). However, the prevalence of ED and other related aspects in this patient population is not known. Objectives: To assess and describe the prevalence, clinical features, treatment, and risk factors for ED in outpatients with advanced LC. Design: Multicenter cross-sectional study. Subjects: Consecutive sample of adult outpatients with advanced LC. Measurements: We assessed background dyspnea (BD), the characteristics, triggers, and management of ED. Potential ED risk factors were assessed through multivariate logistic regression. Results: A total of 366 patients were surveyed. Overall, the prevalence of ED was 31.9% (90% in patients reporting BD). Patients reported a median of one episode per day (interquartile range [IQR]: 1-2), with a median intensity of 7/10 (IQR: 5-8.25). ED triggers were identified in 89.9% of patients. ED was significantly associated with chronic obstructive pulmonary disease (p = 0.011), pulmonary vascular disease (p = 0.003), cachexia (p = 0.002), and palliative care (p < 0.001). Continuous oxygen use was associated with higher risk of ED (odds ratio: 9.89; p < 0.001). Opioids were used by 44% patients with ED. Conclusions: ED is highly prevalent and severe in outpatients with advanced LC experiencing BD. The association between intrathoracic comorbidities and oxygen therapy points to alveolar oxygen exchange failure having a potential etiopathogenic role in ED in this population. Further studies are needed to better characterize ED in LC to better inform treatments and trial protocols.
Subject(s)
Lung Neoplasms , Pulmonary Disease, Chronic Obstructive , Adult , Cross-Sectional Studies , Dyspnea/epidemiology , Dyspnea/etiology , Dyspnea/therapy , Humans , Lung Neoplasms/complications , Outpatients , Oxygen/therapeutic use , PrevalenceABSTRACT
La población con enfermedad avanzada al final de la vida, la más vulnerable, ha sufrido sobremanera la escasa atención presencial durante la pandemia. Describimos tres experiencias diferentes en relación con la atención domiciliaria de esta población no COVID
The population with advanced disease at the end of life, the most vulnerable one, has suffered greatly from the limited in-person care during the pandemic. We describe three different experiences in relation to home care for this non-COVID population
Subject(s)
Humans , Home Care Services/organization & administration , Palliative Care/methods , Pandemics/prevention & control , Contingency Plans , Primary Health Care/organization & administration , Coronavirus Infections/prevention & control , Hospice Care/methods , Grief , Bereavement/psychologyABSTRACT
BACKGROUND: Episodic dyspnea is an increasingly recognized phenomenon that occurs frequently in patients with cancer. Although numerous definitions have been proposed to describe episodic dyspnea, to date, no common widely accepted definition in Spanish has yet emerged. Without a clear well-accepted definition, it is difficult to design rigorous clinical trials to evaluate candidate treatments for this emerging entity and to compare outcomes among studies. OBJECTIVE: The aim of the study was to reach a consensus definition of episodic dyspnea in the Spanish language based on professional criteria in cancer patients. DESIGN: A two-round Delphi study. SETTING/SUBJECTS: Sixty-one Spanish specialists in medical oncology, radiation oncology, pneumology, palliative care, and pain management participated in the study. MEASUREMENTS: Sixteen different questions on dyspnea-related terminology, including the definition of episodic dyspnea, were assessed. RESULTS: The panel of experts reached a consensus on 75% of the 16 assessments proposed: 56.25% in agreement and 18.75% in disagreement. The term that most panelists considered most appropriate to define dyspnea exacerbation was dyspnea crisis. The panelists disagreed that dyspnea exacerbation is equivalent to dyspnea at effort and that the presence of dyspnea at rest is required for exacerbation to occur. However, there was wide agreement that exacerbation may or may not be predictable and can be triggered by comorbidities as well as emotional, environmental, or effort factors. CONCLUSIONS: The broad consensus reached in this study is a necessary first step to design high-quality methodological studies to better understand episodic dyspnea and improve treatment.
Subject(s)
Dyspnea/classification , Dyspnea/etiology , Neoplasms/complications , Terminology as Topic , Delphi Technique , Humans , SpainABSTRACT
No disponible
Subject(s)
Humans , Male , Aged, 80 and over , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/pathology , Pancreatic Neoplasms/surgery , Peritoneal Neoplasms/diagnosis , Peritoneal Neoplasms/surgery , Palliative Care/methods , Palliative CareABSTRACT
No disponbile
Subject(s)
Humans , Sarcoma, Synovial/diagnosis , Lung Neoplasms/diagnosis , Biopsy/methodsABSTRACT
No disponible
Subject(s)
Humans , Diphosphonates/adverse effects , /epidemiology , Risk Factors , Osteoporosis/drug therapySubject(s)
Humans , Lung Neoplasms/blood , Lung Neoplasms/mortality , Hemoglobins/analysis , Survival RateSubject(s)
Hemoglobins/analysis , Lung Neoplasms/blood , Lung Neoplasms/mortality , Humans , Survival RateABSTRACT
PURPOSES: Dyspnea as refractory symptom leading to sedation at the end of life and the place of death. Survival study in population with dyspnea. METHODS: Longitudinal study of terminally ill patients in a year (n = 195). We divided populations as (a) population with dyspnea: prevalent and incident dyspnea and (b) population without dyspnea. We used the statistical program Stata9 (Kaplan-Meier and Cox logistic regression models). RESULTS: The probability of being sedated was 5 times higher in population with dyspnea. Dying in hospital odds ratio was 2.13 in patients with dyspnea. The average survival time was 52 days in patients with dyspnea and 69 in non-dyspnea patients. The average survival was similar between both groups. Patients with incident dyspnea showed a higher average survival than those with prevalent dyspnea. CONCLUSIONS: The connection between dyspnea and sedation was clearly shown. There were significant differences between prevalent dyspnea and incident dyspnea groups.
Subject(s)
Dyspnea/mortality , Dyspnea/prevention & control , Palliative Care/statistics & numerical data , Severity of Illness Index , Terminally Ill/statistics & numerical data , Aged , Aged, 80 and over , Cause of Death , Female , Humans , Hypnotics and Sedatives/administration & dosage , Kaplan-Meier Estimate , Longitudinal Studies , Male , Middle Aged , Prevalence , Prognosis , Quality of Life , Spain/epidemiology , Survival Analysis , Survival RateSubject(s)
Dyspnea/prevention & control , Hydromorphone/administration & dosage , Sodium Chloride/administration & dosage , Administration, Inhalation , Administration, Oral , Aged , Aged, 80 and over , Analgesics, Opioid/administration & dosage , Cross-Over Studies , Double-Blind Method , Female , Humans , Injections, Intra-Arterial , Male , Middle Aged , Nebulizers and Vaporizers , Pilot Projects , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Humans , Mental Disorders/epidemiology , Neoplasms/psychology , Truth DisclosureABSTRACT
La disnea en pacientes con cáncer avanzado es un síntoma muy común (hasta el 65% de los casos) y discapacitante que origina un marcado deterioro de la calidad de vida; de ahí la importancia de valorarla de manera multidimensional, con el fin de actuar en los distintos factores que la desencadenan. En la actualidad el tratamiento sintomático de elección es con opiáceos, en concreto la morfina, de la que se aportan evidencias al respecto. El tratamiento paliativo de los pacientes con derrame pleural maligno tiene como finalidad el alivio de la disnea. La pleurodesis química es la modalidad terapéutica más utilizada. Para los sujetos en que fracasa la pleurodesis, se debe de considerar la inserción de catéter endopleural (AU)
Dyspnea in patients with advanced cancer is a highly frequent (affecting up to 65% of patients) and incapacitating symptom that markedly worsens quality of life; hence the importance of multidimensional evaluation of dyspnea with the aim of acting on the various triggering factors. Currently, the symptomatic treatment of choice consists of opioids, specifically morphine, which is discussed in the present article. The aim of palliative treatment in patients with malignant pleural effusion is to relieve dyspnea. The most widely used therapeutic modality is chemical pleurodesis. In patients unresponsive to pleurodesis, insertion of an endopleural catheter should be considered (AU)
