Evidence-based Treatment for Dyspnea in an End-stage Cancer Patient_Chinese Journal of Evidence-Based Medicine

Authors：

SHU Defen ,  Dong Birong

Department of Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

Dong Birong, Email: birongdong@hotmail.com

Keywords：

Evidence-based treatment; End-stage cancer; Dyspnea

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Objective 　To identify the best therapy regime for dyspnea in an end-stage cancer patient.
Method 　We searched The Cochrane Library (Issue 2, 2006), SUMsearch (1978 to 2006) and MEDLINE (1978 to 2006), and identified 4 systematic reviews and 28 randomised controlled trials. We critically assessed the quality of these studies.
Result　 Evidence supported the use of breathing exercise, desensitisation, oral or parenteral opioids and antianxiety　drugs to pall iate breathlessness. Patients with hypoxemia were found to benefit from oxygen therapy.
Conclusions　 Physiotherapy, psychotherapy, oxygen therapy, opioids and antianxiety drugs can be considered in treating cancer patients with dyspnea.

Citation： SHU Defen,Dong Birong. Evidence-based Treatment for Dyspnea in an End-stage Cancer Patient. Chinese Journal of Evidence-Based Medicine, 2007, 07(10): 757-760. doi: Copy

1.	Mancini I, Body JJ. Assessment of dyspnea in advanced cancer patients. Support Care Cancer, 1999; 7(4): 229-232.
2.	Guyatt GH, Rennie D, Editors, The Evidence-Based Medicine Working Group. Users Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice. Chicago: AMA Press; 2002.
3.	Solà I, Thompson E, Subirana M, et al. Non-invasive interventions for improving well-being and quality of life in patients with lung cancer. The Cochrane Database of Systematic Reviews 2004, Issue 4.
4.	Jennings AL, Davies AN, Higgins JPT, et al. Opioids for the palliation of breathlessness in terminal illness. The　Cochrane Database of Systematic Reviews 2001, Issue 3.
5.	Cohen MH, Anderson AJ, Krasnow SH, et al. Continuous intravenous infusion of morphine for severe dyspnea. South Med J, 1991; 84(2): 229-234.
6.	Mazzocato C, Bucl in T, Rapin CH. The effects of morphine on dyspnea and ventilatory function in elderly patients with advanced cancer: a randomized double-blind controlled trial. Ann Oncol, 1999; 10(12): 1511-1514.
7.	Hu WY, Chiu TY, Cheng SY, et al. Morphine for dyspnea control in terminal cancer patients: is it appropriate in Taiwan? J Pain Symptom Manage, 2004; 28(4): 356-363.
8.	Grimbert D, Lubin O, de Monte M, et al. Dyspnea and morphine aerosols in the palliative care of lung cancer. Rev Mal Respir, 2004 ; 21(6 Pt 1): 1091-1097.
9.	Zeppetella G. Nebul ized morphine in the palliation of dyspnoea. Palliat Med, 1997; 11(4): 267-275.
10.	Bruera E, Sala R, Spruyt O, et al. Nebulized versus subcutaneous morphine for patients with cancer dyspnea: a preliminary study. J Pain Symptom Manage, 2005; 29(6): 613-618.
11.	Zebraski SE, Kochenash SM, Raffa RB. Lung opioid receptors: pharmacology and possible target for nebulized morphine in dyspnea. Life Sci, 2000; 66(23): 2221-2231.
12.	Elsasser S, Perruchoud AP. The treatment of terminal dyspnea. Schweiz Rundsch Med Prax, 1992; 81(1-2): 11-14.
13.	Thomas JR, von Gunten CF. Clinical management of dyspnoea. Lancet Oncol, 2002; 3(4): 223-228.
14.	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.
15.	Bruera E, de Stoutz N, Velasco-Leiva A, et al. Effects of oxygen on dyspnoea in hypoxaemic terminal-cancer patients. Lancet, 1993; 342(8862): 13-14.
16.	Bruera E, Schoeller T, MacEachern T. Symptomatic benefit of supplemental oxygen in hypoxemic patients with terminal cancer: the use of the N of 1 randomized controlled trial. J Pain Symptom Manage, 1992; 7(6): 365-368.
17.	Bruera E, Sweeney C, Willey J, et al. A randomized controlled trial of supplemental oxygen versus air in cancer patients with dyspnea. Palliat Med, 2003; 17(8): 659-663.

1. Mancini I, Body JJ. Assessment of dyspnea in advanced cancer patients. Support Care Cancer, 1999; 7(4): 229-232.
2. Guyatt GH, Rennie D, Editors, The Evidence-Based Medicine Working Group. Users Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice. Chicago: AMA Press; 2002.
3. Solà I, Thompson E, Subirana M, et al. Non-invasive interventions for improving well-being and quality of life in patients with lung cancer. The Cochrane Database of Systematic Reviews 2004, Issue 4.
4. Jennings AL, Davies AN, Higgins JPT, et al. Opioids for the palliation of breathlessness in terminal illness. The　Cochrane Database of Systematic Reviews 2001, Issue 3.
5. Cohen MH, Anderson AJ, Krasnow SH, et al. Continuous intravenous infusion of morphine for severe dyspnea. South Med J, 1991; 84(2): 229-234.
6. Mazzocato C, Bucl in T, Rapin CH. The effects of morphine on dyspnea and ventilatory function in elderly patients with advanced cancer: a randomized double-blind controlled trial. Ann Oncol, 1999; 10(12): 1511-1514.
7. Hu WY, Chiu TY, Cheng SY, et al. Morphine for dyspnea control in terminal cancer patients: is it appropriate in Taiwan? J Pain Symptom Manage, 2004; 28(4): 356-363.
8. Grimbert D, Lubin O, de Monte M, et al. Dyspnea and morphine aerosols in the palliative care of lung cancer. Rev Mal Respir, 2004 ; 21(6 Pt 1): 1091-1097.
9. Zeppetella G. Nebul ized morphine in the palliation of dyspnoea. Palliat Med, 1997; 11(4): 267-275.
10. Bruera E, Sala R, Spruyt O, et al. Nebulized versus subcutaneous morphine for patients with cancer dyspnea: a preliminary study. J Pain Symptom Manage, 2005; 29(6): 613-618.
11. Zebraski SE, Kochenash SM, Raffa RB. Lung opioid receptors: pharmacology and possible target for nebulized morphine in dyspnea. Life Sci, 2000; 66(23): 2221-2231.
12. Elsasser S, Perruchoud AP. The treatment of terminal dyspnea. Schweiz Rundsch Med Prax, 1992; 81(1-2): 11-14.
13. Thomas JR, von Gunten CF. Clinical management of dyspnoea. Lancet Oncol, 2002; 3(4): 223-228.
14. 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.
15. Bruera E, de Stoutz N, Velasco-Leiva A, et al. Effects of oxygen on dyspnoea in hypoxaemic terminal-cancer patients. Lancet, 1993; 342(8862): 13-14.
16. Bruera E, Schoeller T, MacEachern T. Symptomatic benefit of supplemental oxygen in hypoxemic patients with terminal cancer: the use of the N of 1 randomized controlled trial. J Pain Symptom Manage, 1992; 7(6): 365-368.
17. Bruera E, Sweeney C, Willey J, et al. A randomized controlled trial of supplemental oxygen versus air in cancer patients with dyspnea. Palliat Med, 2003; 17(8): 659-663.

Chinese Journal of Evidence-Based Medicine

Evidence-based Treatment for Dyspnea in an End-stage Cancer Patient

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