Direct tumor effects such as intrinsic or extrinsic airway obstruction, pleural involvement, parenchymal involvement by either primary or metastatic disease, superior vena cava syndrome, lymphangitic carcinomatosis, pericardial effusion, and postobstructive pneumonitis.One approach is to divide direct causes into the following four groups: The direct causes of dyspnea in patients with advanced cancer are numerous categorizing them can assist in the etiologic work-up. Feedback from afferents in the respiratory system.The intensity of air hunger and unsatisfied inspiration is caused by the following: Tightness is caused by stimulation of airway receptors with bronchoconstriction. The experience of excess work and effort is caused by sensory-perceptual mechanisms similar to those involved in muscles exercising. The qualities of dyspnea can be appreciated as work/effort, tightness, and air hunger. Peripheral and central mechanisms as well as mechanical and chemical pathways are involved with a variety of sensory afferent sources. The pathophysiological mechanisms of breathlessness are numerous and complex. Another study revealed that one-half of patients with advanced cancer scored their dyspnea as moderate to severe. About one-third of patients who could report the intensity of their dyspnea rated it as moderate to severe. Results of a large study showed that 70% of patients suffered from dyspnea in the last 6 weeks of life. Breathlessness was a complaint at presentation in 60% of 289 patients with lung cancer. One study found that 75 of 135 patients with advanced cancer reporting to an outpatient palliative care clinic were experiencing moderate-to-severe dyspnea. Patients with advanced cancer experience this symptom more frequently and more intensely than do patients with limited disease. In one study, 49% of a general cancer population reported breathlessness, and 20% rated their breathlessness as moderate to severe. Reports on the frequency of dyspnea also vary, depending on the setting and the extent of disease. Terms such as tightness and suffocating are sometimes used.
Patients use a host of different words and phrases to describe the sensation of breathlessness. Patients with comparable degrees of functional lung impairment and disease burden may describe varying intensities of dyspnea. It is a subjective experience involving many factors that modulate the quality and intensity of its perception. J Clin Oncol 26 (23): 3886-95, 2008.ĭyspnea is defined as an uncomfortable awareness of breathing. Komaroff AL: Symptoms: in the head or in the brain? Ann Intern Med 134 (9 Pt 1): 783-5, 2001.ĭy SM, Lorenz KA, Naeim A, et al.: Evidence-based recommendations for cancer fatigue, anorexia, depression, and dyspnea. Yancik R, Ganz PA, Varricchio CG, et al.: Perspectives on comorbidity and cancer in older patients: approaches to expand the knowledge base. When specific information about the care of children is available, it is summarized under its own heading.
The evidence and application to practice related to children may differ significantly from information related to adults. In this summary, unless otherwise stated, evidence and practice issues as they relate to adults are discussed. Important cardiopulmonary syndromes include the following: Optimal treatment requires an understanding of contributing etiologies and pathophysiologies to direct therapeutic interventions as clinically appropriate. Dyspnea is a common symptom of certain cancers such as lung cancer and is also common in patients with numerous advanced cancers. In addition, these clinicians need to be familiar with some cancer-specific aspects of chest symptoms and syndromes. Cancer patients are often also at higher risk of developing pulmonary infections.Ĭlinicians caring for cancer patients should be familiar with the assessment and treatment of common conditions that manifest as chest symptoms. Evidence-based recommendations describing various approaches to the problems of cancer-related fatigue, anorexia, depression, and dyspnea have been published. Because many advanced cancers spread to the thorax, symptoms such as dyspnea, cough, chest pain, or palpitations often present a challenge in sorting out the likely cause of the problem and developing appropriate interventions. Whether patients are seen in primary care or cancer care settings, unexplained symptoms often frustrate physicians and patients.
In fact, patients older than 65 years bear a disproportionate burden of cancer as well as increased prevalence of medical problems such as chronic obstructive pulmonary disease, heart disease, diabetes, and hypertension. Cancer patients often have comorbid medical problems in addition to their underlying malignant disorders.
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