Pharmacologic and Non-Pharmacologic Dyspnea Management in Advanced Cancer Patients

Author(s):  
Rachel A. Zemel

As there is a high propensity for patients with advanced malignancy to experience refractory dyspnea, it is necessary for physicians to be well-versed in the management of these patients’ dyspneic symptoms. For symptomatic treatment of cancer patients with dyspnea, both pharmacologic and non-pharmacologic methods should be considered. The main source of pharmacologic symptom management for dyspnea is oral and parenteral opioids; benzodiazepines and corticosteroids may serve as helpful adjuncts alongside opioid treatments. However, oxygen administration and nebulized loop diuretics have not been shown to clinically benefit dyspneic cancer patients. Applying non-pharmacologic dyspnea management methods may be valuable palliative therapies for advanced cancer patients, as they provide benefit with negligible harm to the patient. Advantageous and minimally harmful non-pharmacologic dyspnea therapies include facial airflow, acupuncture and/or acupressure, breathing exercises, cognitive behavioral therapy, music therapy, and spiritual interventions. Thus, it is vital that physicians are prepared to provide symptomatic care for dyspnea in advanced cancer patients as to minimize suffering in this patient population during definitive cancer treatments or hospice care.

2013 ◽  
Vol 16 (10) ◽  
pp. 1249-1254 ◽  
Author(s):  
Elizabeth T. Loggers ◽  
Paul K. Maciejewski ◽  
Rachel Jimenez ◽  
Matthew Nilsson ◽  
Elizabeth Paulk ◽  
...  

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24002-e24002
Author(s):  
Shamali Poojary ◽  
Jayita Deodhar ◽  
Akanksha Chodankar ◽  
Anuja Damani ◽  
Arunangshu Ghoshal ◽  
...  

e24002 Background: Patients with advanced malignancy have complex symptoms towards end of life. Some of these symptoms include febrile illness and infections. Benefits of treating infection and fever with antibiotics should be weighed out with goals of care for these patients. This study aims to understand the frequency of use of antibiotics and its association with symptom control in the last two weeks of life in advanced cancer patients on best supportive care. Methods: This is an observational retrospective analysis of medical records maintained for advanced cancer patients who have been enrolled in home-based palliative care services. 8 months data was analyzed. Sociodemographic variables, cancer diagnoses, symptoms, use and type of antibiotics prescribed were noted. Relevant statistical analysis was done using IBM SPSS v 25. Results: Of 256 patients included in the analysis, 133 (52%) were male. 57 (22.3% ) patients had gastrointestinal (GI) cancer and 45 ( 17.6%) had lung cancer. 175 (68.4)% died at home and 50 (19.5%) in hospital. 9 (3.1 %) patients had fever. 10 (3.9%) patient had respiratory, and 18 (7%) had gastrointestinal symptoms, respectively. Other symptoms noted were wound infection (10,3.9%), skin and soft tissue (5,2%). Other symptoms noted were wound infection (10,3.9%), skin and soft tissue (5,2%). Only 2 patients had urinary tract symptom. 49 (19.1%) patients had received antibiotics in their last two weeks of life. Intravenous (IV) route of administration was slightly higher than oral (28 vs 21 patients).More than half the patients received 2 antibiotics. Amoxicillin/clavulanate was the most common oral antibiotic and Cefoperazone/ sulbactam was the most common IV antibiotic. Symptom relief was noted in 9 patients (18.4%) however it was statistically significant (p<0.001). Conclusions: Of 256 patients included in the study, 19% had received antibiotics in last two week of their life. Use of intravenous route for antibiotic administration was more than oral route. Gastrointestinal and respiratory symptoms were common cause for antibiotic prescription. Symptomatic benefit was noted with antibiotics use in these patients. Judicious use of antibiotics during end of life care should be considered.


2009 ◽  
Vol 12 (1) ◽  
pp. 20-26 ◽  
Author(s):  
Der Sheng Sun ◽  
Yeon Joo Chun ◽  
Jeong Hwa Lee ◽  
Sang Hyun Gil ◽  
Byoung Yong Shim ◽  
...  

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8572-8572
Author(s):  
L. Dias ◽  
E. Lamont

8572 Background: Despite the fact that cancer is the second leading cause of death in the US and represents the most frequent diagnosis among hospice patients, little is known about the factors that influence oncologists in their decision making around end of life care. Methods: We surveyed all clinically active medical oncology attending and fellow physicians at two affiliated academic medical centers eliciting oncologists’ attitudes and practices regarding care of cancer patients at the end of life. Included in the survey were a series of randomized vignettes describing patients with advanced solid tumors. Oncologists were asked to describe their next treatment recommendations. Results: Of the 181 oncologists contacted for survey participation, 116 (64%) returned completed questionnaires. Sixty six percent (77/116) of respondents were attending physicians and 34% (39/116) were fellows. Sixty-five percent favored concurrent treatment with third-line chemotherapy and hospice if insurance would allow. Eighty percent (93/116) agreed that patients with advanced cancer should be able to receive hospice care even if they are receiving anti-tumor therapies. Results of randomized scenarios suggest that advanced patient age was positively associated with earlier referral to hospice care and that prior treatment on a clinical trial, although not statistically significant, was modestly associated with delayed referral to hospice (1.49, 95% CI 0.71–3.11). Conclusions: Among oncologists at two academic centers, chemotherapy is an important modality for management of advanced cancer patients at the end of life. Therefore, insurance policies that prohibit chemotherapy for hospice patients may constrain oncologists in their management of such patients. No significant financial relationships to disclose.


2017 ◽  
Vol 168 (13-14) ◽  
pp. 333-343 ◽  
Author(s):  
Matthäus Strieder ◽  
Martin Pecherstorfer ◽  
Gudrun Kreye

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