Management of dyspnea in older adults with cancer

Dyspnea, a complex psychophysiologic phenomenon characterized by the sensation of breathlessness, afflicts a substantial proportion of advanced cancer patients. Reported prevalences range from 15 to 79 percent, depending on the primary tumor site and other factors. A prospective study of 1,860 adult patients with advanced cancer found an overall prevalence of 19 percent, with highest prevalence (46%) among lung cancer patients and lowest (6%) among head and neck cancer patients. Another prospective study in a general cancer population (n = 923) reported an overall dyspnea prevalence of 46 percent. Among a general population in the community (n = 8,396), the prevalence of substantial breathlessness that limits exertion is 9 percent. Among terminally ill cancer patients, a retrospective analysis of National Hospice Study data found that prevalence rates generally exceeded 50 percent. For elderly cancer patients, dyspnea can be especially troubling. In a Finnish study of consecutive cancer patients with heterogeneous diagnoses (n = 203, mean age 65 years), dyspnea ranked among the four most disturbing symptoms as reported by patients on the Edmonton Symptom Assessment System, ranking symptoms on a scale of 0–10. Forty-nine percent of total respondents reported experiencing dyspnea; 18 percent reported a dyspnea score of 4 or greater. A Taiwanese study of symptom patterns of advanced cancer patients in a palliative care unit (n = 77, mean age 62 years) found that dyspnea was experienced by 49 percent of patients on admission, 42 percent 1 week after admission, and 67 percent 2 days before death; of 19 symptoms monitored, only dyspnea and anorexia exhibited a pattern of decrease then increase.