Evaluation and management of dyspnoea

Dyspnoea is one of the commonest symptoms experienced by patients with cancer-both as a feature of the disease and also as a consequence of its treatments. In a recent Canadian series of nearly 1000 cancer out-patients, 46 % reported dyspnoea (1). The Medical Research Council (MRC) of the UK has found that of lung cancer patients entering its trials, dyspnoea was a presenting complaint in 87 % of small cell cancer and in 86 % of non-small cell cancer patients. In advanced cancer, 33 % of patients entering a Japanese hospice reported dyspnoea but that rose to 66 % near to death (2). CAUSATION Dyspnoea is the end result of many discrete but overlapping potential pathways of pathophysiological change that can occur in patients with cancer. These are modified and may be amplified by:- Co-morbidities (especially COPD, other chronic lung diseases and heart disease);- De-conditioning associated with immobility and cancer cachexia;- Effects of ageing; In any single patient, several of these factors could be involved, to produce a symptom level and an effect on functioning and quality of life. Thus, the assessment and management of dyspnoea requires a good understanding of the underlying mechanisms. However, the clinical features displayed by patients with dyspnoea are often non-specific and this ofte