Skip to main content

Management of Respiratory Symptoms in People with Cancer

  • Chapter
  • First Online:
The MASCC Textbook of Cancer Supportive Care and Survivorship
  • 1226 Accesses

Abstract

Cancer-related respiratory symptoms are a burdensome constellation with substantial morbidity. Dyspnoea is a subjective experience of breathing discomfort that may be encountered anywhere across the cancer continuum and especially towards the end of life; dyspnoea can be addressed by treating the underlying disease or through global symptom-specific interventions aimed at reducing symptoms, increasing function, and improving quality of life. Options for the management of refractory breathlessness include opioids, oxygen, psychotropic drugs, inhaled frusemide, Heliox28, breathing techniques, and breathlessness clinics, although the evidence varies. Other respiratory symptoms such as cough, haemoptysis, pleural effusion, and hoarse voice also lead to increased cancer-patient distress and require similar systematic approaches for diagnosis, treatment planning, and review to reduce their burden.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Williams M, Cafarella BA, Olds T, et al. The language of breathlessness differentiates between patients with COPD and age-matched adults. Chest. 2008;134(3):489–496.

    Article  PubMed  Google Scholar 

  2. Hardy JR, Turner R, Saunders M, A Hern R. Prediction of survival in a hospital-based continuing care unit. Eur J Cancer. 1994;30A(3):284–288.

    Article  PubMed  CAS  Google Scholar 

  3. Chang VT, Thaler HT, Polyak TA, et al. Quality of life and survival: the role of multidimensional symptom assessment. Cancer. 1998;83(1):173–179.

    Article  PubMed  CAS  Google Scholar 

  4. Anonymous. Dyspnea. Mechanisms, assessment, and management: a consensus statement. American Thoracic Society. Am J Respir Crit Care Med. 1999;159(1):321–340.

    Google Scholar 

  5. Currow DC, Plummer JL, Crockett A, et al. A community population survey of prevalence and severity of dyspnea in adults. J Pain Symptom Manage. 2009;38(4):533–545.

    Article  PubMed  Google Scholar 

  6. Reuben DB, Mor V. Dyspnea in terminally ill cancer patients. Chest. 1986;89(2):234–236.

    Article  PubMed  CAS  Google Scholar 

  7. Dudgeon DJ, Kristjanson L, Sloan JA, et al. Dyspnea in cancer patients: prevalence and associated factors. J Pain Symptom Manage. 2001;21(2):95–102.

    Article  PubMed  CAS  Google Scholar 

  8. Currow DC, Smith J, Davidson PM, et al. Do the trajectories of dyspnoea differ in prevalence and intensity by diagnosis at the end of life? A consecutive cohort study. J Pain Symptom Manage. 2010;39:680–690.

    Article  PubMed  Google Scholar 

  9. Tsai J-S, Wu C-H, Chiu T-Y, et al. Symptom patterns of advanced cancer patients in a palliative care unit. Palliat Med. 2006;20(6):617–622.

    Article  PubMed  Google Scholar 

  10. Chiu T-Y, Hu W-Y, Lue B-H, et al. Dyspnea and its correlates in Taiwanese patients with terminal cancer. J Pain Symptom Manage. 2004;28(2):123–132.

    Article  PubMed  Google Scholar 

  11. Vainio A, Auvinen A. Prevalence of symptoms among patients with advanced cancer: an international collaborative study. Symptom Prevalence Group. J Pain Symptom Manage. 1996;12(1):3–10.

    Article  PubMed  CAS  Google Scholar 

  12. Mercadante S, Casuccio A, Fulfaro F. The course of symptom ­frequency and intensity in advanced cancer patients followed at home. J Pain Symptom Manage. 2000;20(2):104–112.

    Article  PubMed  CAS  Google Scholar 

  13. Abernethy AP, Wheeler JL. Total dyspnoea. Curr Opin Support Palliat Care. 2008;2(2):110–113.

    Article  PubMed  Google Scholar 

  14. Edmonds P, Higginson I, Altmann D, et al. Is the presence of ­dyspnea a risk factor for morbidity in cancer patients? J Pain Symptom Manage. 2000;19(1):15–22.

    Article  PubMed  CAS  Google Scholar 

  15. Seamark DA, Blake SD, Seamark CJ, et al. Living with severe chronic obstructive pulmonary disease (COPD): perceptions of patients and their carers. An interpretative phenomenological ­analysis. Palliat Med. 2004;18(7):619–625.

    Article  PubMed  CAS  Google Scholar 

  16. Currow DC, Ward AM, Clark K, et al. Caregivers for people with end-stage lung disease: characteristics and unmet needs in the whole population. Int J Chron Obstruct Pulmon Dis. 2008;3(4):753–762.

    PubMed  Google Scholar 

  17. Booth S, Silvester S, Todd C. Breathlessness in cancer and chronic obstructive pulmonary disease: using a qualitative approach to describe the experience of patients and carers. Palliat Support Care. 2003;1(4):337–344.

    PubMed  Google Scholar 

  18. Wilcock A, Maddocks M, Lewis M, et al. Symptoms limiting ­activity in cancer patients with breathlessness on exertion: ask about muscle fatigue. Thorax. 2008;63(1):91–92.

    Article  PubMed  CAS  Google Scholar 

  19. Tanaka K, Akechi T, Okuyama T, et al. Development and validation of the Cancer Dyspnoea Scale: a multidimensional, brief, self-­rating scale. Br J Cancer. 2000;82(4):800–805.

    Article  PubMed  CAS  Google Scholar 

  20. Bausewein C, Farquhar M, Booth S, et al. Measurement of breathlessness in advanced disease; a systematic review. Respir Med. 2007;101(3):399–410.

    Article  PubMed  CAS  Google Scholar 

  21. Jennings AL, Davies AN, Higgins JPT, et al. A systematic review of the use of opioids in the management of dyspnoea. Thorax. 2002;57:939–944.

    Article  PubMed  Google Scholar 

  22. Viola R, Kiteley C, Lloyd NS, et al. The management of dyspnea in cancer patients: a systematic review. Support Care Cancer. 2008;16(4):329–337.

    Article  PubMed  Google Scholar 

  23. Ben-Aharon I, Gafter-Gvili PM, Leibovici L, et al. Interventions for alleviating cancer-related dyspnea: a systematic review. J Clin Oncol. 2008;28(14):2396–2404.

    Article  Google Scholar 

  24. Uronis HE, Currow DC, McCrory DC, et al. Oxygen for relief of dyspnoea in mildly- or non-hypoxaemic patients with cancer: a syste­matic review and meta-analysis. Br J Cancer. 2008;98(2):294–299.

    Article  PubMed  CAS  Google Scholar 

  25. Mahler DA, Murray JA, Waterman LA, et al. Endogenous opioids modify dyspnoea during treadmill exercise in patients with COPD. Eur Respir J. 2009;33:771–777.

    Article  PubMed  CAS  Google Scholar 

  26. Currow DC, Abernethy AP, Frith P. Morphine for management of refractory dyspnea. BMJ. 2003;327:1288–1289.

    Article  Google Scholar 

  27. Abernethy AP, McDonald CF, Frith PA, et al. Effect of palliative oxygen versus medical (room) air in relieving breathlessness in patients with refractory dyspnea: a double-blind randomized controlled trial (NCT00327873). Lancet 2010 (In press).

    Google Scholar 

  28. Navigante AH, Cerchietti LC, Castro MA, et al. Midazolam as adjunct therapy to morphine in the alleviation of severe dyspnea perception in patients with advanced cancer. J Pain Symptom Manage. 2006;31(1):38–47.

    Article  PubMed  CAS  Google Scholar 

  29. Ong K-C, Kor A-C, Chong W-F, et al. Effects of inhaled furosemide on exertional dyspnea in chronic obstructive pulmonary disease. Am J Resp Crit Care Med. 2004;169(9):1028–1033.

    Article  PubMed  Google Scholar 

  30. Nishino T, Ide T, Sudo T, et al. Inhaled furosemide greatly alleviates the sensation of experimentally induced dyspnea. Am J Respir Crit Care Med. 2000;161(6):1963–1967.

    PubMed  CAS  Google Scholar 

  31. Newton PJ, Davidson PM, Macdonald P, et al. Nebulized furosemide for the management of dyspnoea. Does the evidence support its use? J Pain Symptom Manage. 2008;36(4):424–441.

    Article  PubMed  CAS  Google Scholar 

  32. Stringer E, McParland C, Hernandez P. Physician practices for ­prescribing supplemental oxygen in the palliative care setting. J Palliat Care. 2004;20(4):303–307.

    PubMed  Google Scholar 

  33. Abernethy AP, Currow DC, Frith PA, et al. Prescribing palliative oxygen: a clinician survey of expected benefit and patterns of use. Palliat Med. 2005;19:165–172.

    Article  Google Scholar 

  34. Currow DC, Fazekas B, Abernethy A. Oxygen use – patients define symptomatic benefit discerningly. J Pain Symptom Manage. 2007;34(2):113–114.

    Article  PubMed  Google Scholar 

  35. Corner J, O Driscoll M. Development of a breathlessness assessment guide for use in palliative care. Palliat Med. 1999;13(5):375–384.

    Article  PubMed  CAS  Google Scholar 

  36. Millqvist E, Bende M. Role of the upper airway in patients with chronic cough. Curr Opin Allergy Clin Immunol. 2006;6(1):7–11.

    Article  PubMed  Google Scholar 

  37. Pavord ID, Chung KF. Management of chronic cough. Lancet. 2008;371(9621):1375–1384.

    Article  PubMed  Google Scholar 

  38. Chang AB, Lasserson TJ, Gaffney J, et al. Gastro-oesophageal reflux treatment for prolonged non-specific cough in children and adults. Cochrane Database Syst Rev. 2005;(2):CD004823.

    Google Scholar 

  39. Wee B. Chronic cough. Curr Opin Palliat Care. 2008;2:105–109.

    Article  Google Scholar 

  40. Khaleeq G, Musani AI. Emerging paradigms in the management of malignant pleural effusions. Resp Med. 2008;102:939–948.

    Article  Google Scholar 

  41. Light RW, MacGregor MI, Luchsinger PC, et al. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med. 1972;77(4):507–513.

    PubMed  CAS  Google Scholar 

  42. Light RW. Diagnostic principles in pleural disease. Eur Respir J. 1997;10:476–481.

    Article  PubMed  CAS  Google Scholar 

  43. Porcel JM, Vives M, Vincente de Vera MC, et al. Useful tests on pleural fluid that distinguish transudates from exudates. Ann Clin Biochem. 2001;38(6):671–675.

    Article  PubMed  CAS  Google Scholar 

  44. Maskell NA, Lee YC, Gleeson FV, et al. Randomized trials describing lung inflammation after pleurodesis with talc of varying particle size. Am J Respir Crit Care Med. 2004;170(4):377–382.

    Article  PubMed  Google Scholar 

  45. Shaw P, Agarwal R. Pleurodesis for malignant pleural effusions. Cochrane Database of Syst Rev 2004;(1):CD002916.

    Google Scholar 

  46. Tokuda Y, Matsushima D, Stein GH, et al. Intrapleural fibrinolytic agents for empyema and complicated parapneumonic effusions: a meta-analysis. Chest. 2006;129(3):783–790.

    Article  PubMed  CAS  Google Scholar 

  47. Cameron R, Davies HR. Intrapleural fibrinolytic therapy versus conservative management in the treatment of adult parapneumonic effusions and empyema. Cochrane Database System Rev. 2008;(2):CD002312.

    Google Scholar 

  48. Davies CW, Traill ZC, Gleeson FV, et al. Intrapleural streptokinase in the management of malignant multiloculated pleural effusions. Chest. 1999;115(3):729–733.

    Article  PubMed  CAS  Google Scholar 

  49. North SA, Au HJ, Halls SB, et al. A randomized, phase III, double-blind, placebo-controlled trial of Intrapleural instillation of methylprednisonolone acetate in the management of malignant pleural effusion. Chest. 2003;123(3):822–827.

    Article  PubMed  CAS  Google Scholar 

  50. Kvale PA, Simoff M, Prakash UB. Lung cancer. Palliative care. Chest. 2003;123(1 Suppl):284S–311S.

    Article  PubMed  Google Scholar 

  51. Ung YC, Yu E, Falkson C, et al; The role of high-dose-rate brachytherapy in the palliation of symptoms in patients with non-small-cell lung cancer: a systematic review. Brachytherapy. 2006;5(3):189–202.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to David C. Currow .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Society for Imaging Informatics in Medicine

About this chapter

Cite this chapter

Currow, D.C., Abernethy, A.P. (2010). Management of Respiratory Symptoms in People with Cancer. In: Olver, I. (eds) The MASCC Textbook of Cancer Supportive Care and Survivorship. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-1225-1_12

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-1225-1_12

  • Published:

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4419-1224-4

  • Online ISBN: 978-1-4419-1225-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics