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Symptom correlates of dyspnea in advanced cancer patients using the Edmonton Symptom Assessment System

  • Erin McKenzie
  • Liying Zhang
  • Stephanie Chan
  • Pearl Zaki
  • Yasmeen Razvi
  • May Tsao
  • Elizabeth Barnes
  • Leah Drost
  • Caitlin Yee
  • Matthew Hwang
  • Carlo DeAngelis
  • Edward ChowEmail author
Original Article
  • 30 Downloads

Abstract

Purpose

Dyspnea is frequently experienced in advanced cancer patients and is associated with poor prognosis and functional decline. This study used the Edmonton Symptom Assessment System (ESAS) to characterize the relationship between dyspnea and concurrent symptoms experienced by advanced cancer patients.

Methods

A prospective database was collected and analyzed to extract patient demographics and ESAS scores. Logistic regression analysis and generalized estimating equations (GEE) identified correlations of other ESAS symptoms in three categories: severity of dyspnea (none, mild, moderate, severe), moderate/severe dyspnea (ESAS ≥ 4), and presence of dyspnea (ESAS ≥ 1), at patients’ first visit and over time, respectively.

Results

Multivariable analysis revealed drowsiness (p = 0.001), and anxiety (p = 0.01) and appetite loss (p = 0.02) were associated with increased severity of dyspnea at first visit. Over time, tiredness (p = 0.02), drowsiness (p = 0.04), nausea (p = 0.02), and anxiety (p = 0.0006) were more likely to experience increased dyspnea severity. Tiredness (p = 0.0003), depression (p = 0.03), and appetite loss (p = 0.003) were significant for moderate/severe dyspnea at first visit. Over multiple visits, tiredness (p < 0.0001), anxiety (p = 0.0008), and appetite loss (p = 0.0008) had higher probabilities of moderate/severe dyspnea. For the presence of dyspnea at the first visit, anxiety (p = 0.03) and drowsiness (p = 0.002) were significantly correlated with an increased frequency of dyspnea. Over time, anxiety (p < 0.0001) and drowsiness (p < 0.0001) remained significant with the addition of nausea (p = 0.0007).

Conclusions

The highly interactive relationship between dyspnea and other common cancer symptoms necessitates the development of comprehensive symptom assessments and utilization of multimodal management approaches that consider concurrent symptoms for improved identification and treatment of dyspnea.

Keywords

Dyspnea Terminal cancer Edmonton Symptom Assessment System Symptom management 

Notes

Acknowledgments

We thank the generous support of Bratty Family Fund, Michael and Karyn Goldstein Cancer Research Fund, Joey and Mary Furfari Cancer Research Fund, Pulenzas Cancer Research Fund, Joseph and Silvana Melara Cancer Research Fund, and Ofelia Cancer Research Fund. We thank the support of Medigas.

Compliance with ethical standards

The present study was approved by our institution’s Research Ethics Board.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Reuben DB, Mor V (1986) Dyspnea in terminally ill cancer patients. Chest. 89(2):234–236CrossRefGoogle Scholar
  2. 2.
    Bruera E, Schmitz B, Pither J, Neumann CM, Hanson J (2000) The frequency and correlates of dyspnea in patients with advanced cancer. J Pain Symptom Manag 19(5):357–362CrossRefGoogle Scholar
  3. 3.
    Williams CM (2006) Dyspnea. Cancer J 12(5):365–373CrossRefGoogle Scholar
  4. 4.
    Reddy SK, Parsons HA, Elsayem A, Palmer JL, Bruera E (2009) Characteristics and correlates of dyspnea in patients with advanced cancer. J Palliat Med 12(1):29–36CrossRefGoogle Scholar
  5. 5.
    Gupta D, Lis CG, Grutsch JF (2007) The relationship between dyspnea and patient satisfaction with quality of life in advanced cancer. Support Care Cancer 15(5):533–538CrossRefGoogle Scholar
  6. 6.
    Maltoni M, Caraceni A, Brunelli C, Broeckaert B, Christakis N, Eychmueller S, Glare P, Nabal M, Viganò A, Larkin P, de Conno F, Hanks G, Kaasa S, Steering Committee of the European Association for Palliative Care (2005) Prognostic factors in advanced cancer patients: evidence-based clinical recommendations: a study by the steering committee of the European Association for Palliative Care. J Clin Oncol 23(25):6240–6248CrossRefGoogle Scholar
  7. 7.
    Teunissen SC, de GA, de Haes HC, Voest EE (2006) Prognostic significance of symptoms of hospitalised advanced cancer patients. Eur J Cancer 42(15):2510–2516CrossRefGoogle Scholar
  8. 8.
    Mercadante S, Casuccio A, Fulfaro F (2000) The course of symptom frequency and intensity in advanced cancer patients followed at home. J Pain Symptom Manag 20(2):104–112CrossRefGoogle Scholar
  9. 9.
    Manning HL, Schwartzstein RM (1995) Pathophysiology of dyspnea. N Engl J Med 333(23):1547–1553CrossRefGoogle Scholar
  10. 10.
    Morasso G, Capelli M, Viterbori P, Di Leo S, Alberisio A, Costantini M et al (1999) Psychological and symptom distress in terminal cancer patients with met and unmet needs. J Pain Symptom Manag 17(6):402–409CrossRefGoogle Scholar
  11. 11.
    Dodd M, Janson S, Facione N, Faucett J, Froelicher ES, Humphreys J, Lee K, Miaskowski C, Puntillo K, Rankin S, Taylor D (2001) Advancing the science of symptom management. J Adv Nurs 33(5):668–676CrossRefGoogle Scholar
  12. 12.
    Chang VT, Hwang SS, Feuerman M, Kasimis BS (2000) Symptom and quality of life survey of medical oncology patients at a veterans affairs medical center: a role for symptom assessment. Cancer 88(5):1175–1183CrossRefGoogle Scholar
  13. 13.
    Portenoy RK, Thaler HT, Kornblith AB, Lepore JM, Friedlander-Klar H, Coyle N et al (1994) Symptom prevalence, characteristics and distress in a cancer population. Qual Life Res 3(3):183–189CrossRefGoogle Scholar
  14. 14.
    Bruera E, Neumann C, Brenneis C, Quan H (2000) Frequency of symptom distress and poor prognostic indicators in palliative cancer patients admitted to a tertiary palliative care unit, hospices, and acute care hospitals. J Palliat Care 16(3):16–21CrossRefGoogle Scholar
  15. 15.
    Yogananda MN, Muthu V, Prasad KT, Kohli A, Behera D, Singh N (2018) Utility of the revised Edmonton Symptom Assessment System (ESAS-r) and the Patient-Reported Functional Status (PRFS) in lung cancer patients. Support Care Cancer 26(3):767–775CrossRefGoogle Scholar
  16. 16.
    Chang VT, Hwang SS, Feuerman M (2000) Validation of the Edmonton Symptom Assessment Scale. Cancer 88(9):2164–2171CrossRefGoogle Scholar
  17. 17.
    SAS Insitute. SAS/STAT 9.4 User’s guide: the logistic procedure. Cary, NC;Google Scholar
  18. 18.
    Tanaka K, Akechi T, Okuyama T, Nishiwaki Y, Uchitomi Y (2002) Factors correlated with dyspnea in advanced lung cancer patients. J Pain Symptom Manag 23(6):490–500CrossRefGoogle Scholar
  19. 19.
    Chiu T-Y, Hu W-Y, Lue B-H, Yao C-A, Chen C-Y, Wakai S (2004) Dyspnea and its correlates in Taiwanese patients with terminal cancer. J Pain Symptom Manag 28(2):123–132CrossRefGoogle Scholar
  20. 20.
    Dudgeon DJ, Lertzman M (1998) Dyspnea in the advanced cancer patient. J Pain Symptom Manag 16(4):212–219CrossRefGoogle Scholar
  21. 21.
    Smoller JW, Pollack MH, Otto MW, Rosenbaum JF, Kradin RL (1996) Panic anxiety, dyspnea, and respiratory disease. Theoretical and clinical considerations. Am J Respir Crit Care Med 154(1):6–17CrossRefGoogle Scholar
  22. 22.
    Man GCW, Hsu K, Sproule BJ (1986) Effect of alprazolam on exercise and dyspnea in patients with chronic obstructive pulmonary disease. Chest 90(6):832–836CrossRefGoogle Scholar
  23. 23.
    Navigante AH, Cerchietti LCA, Castro MA, Lutteral MA, Cabalar ME (2006) Midazolam as adjunct therapy to morphine in the alleviation of severe dyspnea perception in patients with advanced cancer. J Pain Symptom Manag 31(1):38–47CrossRefGoogle Scholar
  24. 24.
    Gomutbutra P, O’Riordan DL, Pantilat SZ (2013) Management of moderate-to-severe dyspnea in hospitalized patients receiving palliative care. J Pain Symptom Manag 45(5):885–891CrossRefGoogle Scholar
  25. 25.
    Alius MG, Pané-Farré CA, Von Leupoldt A, Hamm AO (2013) Induction of dyspnea evokes increased anxiety and maladaptive breathing in individuals with high anxiety sensitivity and suffocation fear. Psychophysiology 50(5):488–497CrossRefGoogle Scholar
  26. 26.
    Chan CWH, Richardson A, Richardson J (2011) Managing symptoms in patients with advanced lung cancer during radiotherapy: results of a psychoeducational randomized controlled trial. J Pain Symptom Manag 41(2):347–357CrossRefGoogle Scholar
  27. 27.
    Yohannes AM, Junkes-Cunha M, Smith J, Vestbo J (2017) Management of dyspnea and anxiety in chronic obstructive pulmonary disease: a critical review. J Am Med Dir Assoc 18(12):1096.e1–1096.e17CrossRefGoogle Scholar
  28. 28.
    Pisani L, Hill NS, Pacilli AMG, Polastri M, Nava S (2018) Management of dyspnea in the terminally ill. Chest 154(4):925–934CrossRefGoogle Scholar
  29. 29.
    Chow E, Fan G, Hadi S, Wong J, Kirou-Mauro A, Filipczak L (2008) Symptom clusters in cancer patients with brain metastases. Clin Oncol 20(1):76–82CrossRefGoogle Scholar
  30. 30.
    Mantyh P (2006) The science behind metastatic bone pain. Eur J Cancer Suppl 4(8):4–8CrossRefGoogle Scholar
  31. 31.
    Hird A, Chow E, Zhang L, Wong R, Wu J, Sinclair E, Danjoux C, Tsao M, Barnes E, Loblaw A (2009) Determining the incidence of pain flare following palliative radiotherapy for symptomatic bone metastases: results from three Canadian cancer centers. Int J Radiat Oncol 75(1):193–197CrossRefGoogle Scholar
  32. 32.
    Okuyama T, Akechi T, Kugaya A, Okamura H, Imoto S, Nakano T, Mikami I, Hosaka T, Uchitomi Y (2000) Factors correlated with fatigue in disease-free breast cancer patients: application of the Cancer Fatigue Scale. Support Care Cancer 8(3):215–222CrossRefGoogle Scholar
  33. 33.
    Chen E, Nguyen J, Khan L, Zhang L, Cramarossa G, Tsao M, Danjoux C, Barnes E, Sahgal A, Holden L, Jon F, Chow E (2012) Symptom clusters in patients with advanced cancer: a reanalysis comparing different statistical methods. J Pain Symptom Manag 44(1):23–32CrossRefGoogle Scholar
  34. 34.
    Hayduk L, Olson K, Quan H, Cree M, Cui Y (2010) Temporal changes in the causal foundations of palliative care symptoms. Qual Life Res 19(3):299–306CrossRefGoogle Scholar
  35. 35.
    Bausewein C, Booth S, Higginson IJ (2008) Measurement of dyspnoea in the clinical rather than the research setting. Curr Opin Support Palliat Care 2(2):95–99CrossRefGoogle Scholar
  36. 36.
    Banzett RB, Moosavi SH (2017) Measuring dyspnoea: new multidimensional instruments to match our 21st century understanding. Eur Respir J 49(3):1602473CrossRefGoogle Scholar
  37. 37.
    Cheung WY, Zimmermann C (2011) Pharmacologic management of cancer-related pain, dyspnea, and nausea. Semin Oncol 38(3):450–459CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Erin McKenzie
    • 1
  • Liying Zhang
    • 1
  • Stephanie Chan
    • 1
  • Pearl Zaki
    • 1
  • Yasmeen Razvi
    • 1
  • May Tsao
    • 1
  • Elizabeth Barnes
    • 1
  • Leah Drost
    • 1
  • Caitlin Yee
    • 1
  • Matthew Hwang
    • 1
  • Carlo DeAngelis
    • 1
  • Edward Chow
    • 1
    Email author
  1. 1.Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Sunnybrook Odette Cancer CentreUniversity of TorontoTorontoCanada

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