ABSTRACT
Dyspnea is reported to occur in 30-70%2•3 of patients dying of cancer. The pathophysiology of dyspnea in palliative care is complex.l·2 When present, it is rated as moderate to severe (clinically important for the patient) 63% of the time.4 It is more common in patients with lung, colorectal, and breast cancer.3•5 In one study, patients with dyspnea had lung or pleural involvement 39% of the time. 3
Several authors5•6 have suggested that for many patients the onset of dyspnea may represent the patient's moving to the terminal phase of their disease. Escalante5 evaluated 122 patientswho presented to the emergency room of a major cancer center with dyspnea as the present: ing symptom. Of these patients, 68% had uncontrolled progressive disease, and 50% had more than one etiology for their dyspnea. Thirty-two percent of these patients died on the initial hospitalization. The overall median survival was 12 weeks. In lung cancer patients with dyspnea, 31% died within two weeks; the medial survival was 4 weeks. Higginson6 summarized the symptoms of 86 patients referred to a terminal care support team. Twenty-one percent of patients developed dyspnea as they approached death and dyspnea was described as their most severe symptom. While the pain symptom scores of the patients decreased, those of dyspnea did not. Of the 13 patients with dyspnea as their major symptom at referral, 6 died within 2 weeks of referral. Lynn 7 interviewed the family members of 3,357 patients who were older or seriously ill concerning the death experience. More than half of the patients had severe dyspnea in the last 3 days of life. Fatigue and dyspnea were the most commonly reported symptoms.
