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Who experiences higher and increasing breathlessness in advanced cancer? The longitudinal EPCCS Study

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Abstract

Purpose

Breathlessness is a major cause of suffering in advanced cancer. We aimed to determine the symptom trajectory in people with advanced cancer and to identify those at increased risk of experiencing higher or increasing breathlessness over time in advanced cancer.

Patients and methods

This was an analysis of the multinational, prospective, longitudinal European Palliative Care Cancer Symptom (EPCCS) study. We included adults with confirmed incurable cancer enrolled in palliative care, with prospective monthly assessments for up to 6 months, withdrawal or death, whichever came first. Symptom severity (0–10 numerical rating scales) was analyzed using multivariate random coefficients regression.

Results

A total of 1689 patients (50 % women; mean age 65.7 ± [standard deviation; SD] 12.4 years) were included. Main diagnoses were digestive (31 %), lung (20 %), and breast (17 %) cancers. During a median follow-up of 62 (interquartile range, 0 to 133) days, 65 % were breathless at some point and 36 % of all patients reported moderate/severe breathlessness. The group mean (1.6 points; SD, 2.4) was unchanged over time, but the severity varied markedly between patients and over time. Independent predictors for worse breathlessness were COPD, lung cancer, living alone, lung metastases, anxiety, pain, depression, and lower performance status. Predictors of worsening breathlessness over time were low performance status (p = 0.039) and moderate to severe pain (p = 0.012).

Conclusion

In the largest longitudinal clinical study to date in advanced cancer alone, breathlessness was frequent and associated with factors including respiratory disease, other concurrent unpleasant symptoms, and impaired performance status. Increase in severity over time was predicted by performance status and pain.

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Acknowledgments

Project management

Marianne J. Hjermstad PRC/NTNU; Stein Kaasa, PRC/NTNU/EAPC-RN; Dagny F. Haugen, PRC/NTNU; Pål Klepstad PRC/NTNU, and Gunnhild Jakobsen PRC/NTNU, Norway; Augusto Caraceni, PRC/EAPC-RN and Cinzia Brunelli, PRC/Italy; Per Sjøgren, EAPC-RN, Denmark; Florian Strasser, Switzerland; Barry Laird, PRC/UK.

Project steering committee

Marianne J. Hjermstad PRC/NTNU and Stein Kaasa, PRC/NTNU/EAPC-RN, Norway; Augusto Caraceni, PRC/EAPC-RN and Cinzia Brunelli, PRC/Italy; Per Sjøgren, EAPC-RN, Denmark, Luc Deliens EAPC-RN, Belgium, Mike Bennett; EAPC-RN, UK; David Currow; Australia, Vickie Baracos, Canada.

Core center collaborators, one from each site

Erik Løhre, St. Olavs Hospital-Trondheim University Hospital; Nina Aass, Oslo University Hospital; Elisabeth Brenne, Øya Helsehus; and Inge Raknes, Haraldsplass Deaconess Hospital; Norway; Geana Kurita, Rigshospitalet and Mogens Groenvold, Bispebjerg Hospital, Denmark; Florian Strasser, Cantonal Hospital St. Gallen, and Cristian Camartin, Kantonspital, Graubünden, Switzerland; Alessandra Pigni, Fondazione IRCCS Istituto Nazionale dei Tumori, Luigi Cavanna, Oncologia Medica Ospedale Di PiacenzA; Adriana Turriziani, Hospice Villa Speranza Roma; Franco Rizzi, U.O. Complessa di Cure Palliative e Terapia del Dolore. AO ICP Milan; Laura Piva; Unità di Cure Palliative Azienda Ospedaliera San Paolo, Milan; Giampiero Porzio, Oncologia Medica Università degli Studi, L’Aquila; and Rondini Ermanno, U.O. Oncologia Medica Arcispedale S. Maria Nuova–IRCCS, Reggio Emilia, Italy; Mike Bennett, Leeds Institute of Health Sciences/University of Leeds; Barry Laird, Western General Hospital Edinburgh/Beatson West of Scotland Cancer Centre; Edinburgh; Andrew Wilcock, Nottingham University Hospitals NHS Trust, Nottingham and Karen Harvie, Marie Curie Hospice, Glasgow, UK, Maria Nabal, Hospital Universitário Arnau de Vilanova Lleida, Antonio N. Tejedor, Hospital Centro de Cuidados Laguna, Madrid; Josep Porta Sales, Institut Català d’Oncologia, Barcelona; and Marina Martínez, Clinica Universidad De Navarra Pamplona; Spain; Konrad Fassbender, University of Alberta, Canada, David Currow, Flinders University, Australia; Nikolay Yordanov, Comprehensive Cancer Center Vratsa, Bulgaria; Koen Pardon, Ghent University Hospital Flanders, Belgium; Ioseb Abesadze, Cancer Prevention Center, Tblisi, Georgia Madalena Feio, Instituto Português de Oncologia Francisco Gentil Lisbon, Portugal.

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Authors and Affiliations

  1. Discipline Palliative and Supportive Services, Flinders University, Daws Road, Adelaide, SA, 5001, Australia

    M. Ekström & D. C. Currow

  2. Department of Clinical Sciences, Division of Respiratory Medicine & Allergology, Lund University, SE-221 00, Lund, Sweden

    M. Ekström

  3. Hull York Medical School, University of Hull, Hull, UK

    M. J. Johnson

  4. Section of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden

    L. Schiöler

  5. European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU) and St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway

    S. Kaasa & M. J. Hjermstad

  6. Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway

    S. Kaasa

  7. Regional Centre for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital, Ullevål, Oslo, Norway

    M. J. Hjermstad

  8. European Palliative Care Research Centre, Dept. of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway

    M. J. Hjermstad

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  1. M. Ekström
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  2. M. J. Johnson
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  3. L. Schiöler
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  4. S. Kaasa
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  5. M. J. Hjermstad
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  6. D. C. Currow
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Corresponding author

Correspondence to M. Ekström.

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Funding

This work was supported by grant no. 6070 from the joint Research Council at Norwegian University of Science and Technology (NTNU) and St. Olav’s Hospital, Trondheim University Hospital.

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Ekström, M., Johnson, M.J., Schiöler, L. et al. Who experiences higher and increasing breathlessness in advanced cancer? The longitudinal EPCCS Study. Support Care Cancer 24, 3803–3811 (2016). https://doi.org/10.1007/s00520-016-3207-1

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  • DOI: https://doi.org/10.1007/s00520-016-3207-1

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