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

Ekström, M. LU ; Johnson, M. J.; Schiöler, L.; Kaasa, S.; Hjermstad, M. J. and Currow, D. C. (2016) In Supportive Care in Cancer 24(9). p.3803-3811
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... (More)

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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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Breathlessness, Cancer, COPD, Pain, Palliative care, Predictor
in
Supportive Care in Cancer
volume
24
issue
9
pages
9 pages
publisher
Springer
external identifiers
  • scopus:84964077750
  • wos:000380677200017
ISSN
0941-4355
DOI
10.1007/s00520-016-3207-1
language
English
LU publication?
yes
id
41683db0-20de-42ab-a56c-cad20d78350b
date added to LUP
2016-06-18 14:35:56
date last changed
2017-05-21 04:51:41
@article{41683db0-20de-42ab-a56c-cad20d78350b,
  abstract     = {<p>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.</p>},
  author       = {Ekström, M. and Johnson, M. J. and Schiöler, L. and Kaasa, S. and Hjermstad, M. J. and Currow, D. C.},
  issn         = {0941-4355},
  keyword      = {Breathlessness,Cancer,COPD,Pain,Palliative care,Predictor},
  language     = {eng},
  number       = {9},
  pages        = {3803--3811},
  publisher    = {Springer},
  series       = {Supportive Care in Cancer},
  title        = {Who experiences higher and increasing breathlessness in advanced cancer? The longitudinal EPCCS Study},
  url          = {http://dx.doi.org/10.1007/s00520-016-3207-1},
  volume       = {24},
  year         = {2016},
}