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The Prevalence of Dyspnoea in
Palliative Care
Terence Seemungal
The University of the West Indies
Professor of Medicine
Department of Clinical
Medical Sciences
Programme Director
Postgraduate Medicine
Head, Adult Medicine
Unit, UWI
1
Palliative Care: The
need in T&T
• Three hospitals: EWMSC, POSGH, SFGH
• several doctors did not fully understand the
meaning of the word “palliative” as the majority
thought this exclusively applied to cancer patients
only
• Example: “You mean that you’re looking for cancer
patients?”
• It appeared that the nurses were better able to
identify these patients and showed a better
understanding when asked further about the
patient’s condition
• Unable to quantify these observations at present
Mudden A, Samodee S, Seemungal T. (Unpublished)
By Hospital or
Department
N = 760 pats., 53(6.9%) reqd Pall care
9
9
8
8
7
7
6
6
5
5
4
Hospital(%)
%
4
3
3
2
2
1
1
0
POSGH (N = EWMSC (262)
181)
SFGH (317)
0
Medicine (N = 489)
Surgery (271)
What is dyspnoea?
• Dyspnoea may be defined as the
uncomfortable awareness of
breathing
• The feeling / sensation that you
cannot get enough air into your
lungs
• Shortness of breath
• It is subjective
• It is a symptom
What dyspnoea is not
• Rapid breathing (tachynoea)
• Deep breathing (hyperpnoea)
• Though all of the above may be
associated with dypnoea
Frequency of Dyspnoea
in End Stage Diseases
100
90
80
70
60
% 50
40
30
20
10
St
ro
ke
C
an
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r
H
ea
rt
Fa
il
D
em
M
en
us
tia
cl
e
D
is
(A
LS
)
C
O
PD
0
Edmunds et al. Pall Med 2001; Gibbs Et al. BMJ 1998; Foley et al. Neuol Clin 2001;
Kristjanson et al. Med J Austr 2003 (S); VolpeBT. Neurol Clin 2001;
Dyspnoea Trajectories
• Dyspnea is the most distressing symptom
experienced by critically ill patients at risk for
dying
• New data suggests different stages of onset of
dyspnoea prior to death
• Patients with noncancer diagnoses, particularly
chronic obstructive pulmonary disease, experience
severe dyspnoea for months before death
• whereas patients with cancer even without
apparent cardiorespiratory disease have an
escalation of dyspnoea near death
• The sickest patients and those who are cognitively
impaired or unconscious are not represented
because self-report measures are used
Campbell M. Curr Opin Support Palliat Care. 2012
Cancer patients on
Chemotherapy: Symptoms
Clusters
• One Japanese Study of 462 patients during
follow-up found 4 major clusters of
symptoms:
1) psychosocial issues (insomnia,
psychological distress, decision-making
support);
2) nutrition-gastrointestinal issues (oral
problems, appetite loss, nausea);
3) fatigue; and
4) pain, dyspnea, and numbness.
Yamagish et al. J Pain and Symptom Manage 2009.
Advanced Cancer and
Dyspnoea
• 135 patients with end stage
lung cancer
• Pain Clinic (M.D. Anderson Cancer Centre, Texas)
• Moderate to severe dyspnoea in
55%
• Severity of dyspnoea related to
• lung involvement (P = 0.0016) and
• anxiety (P = 0.0027)
Bruera et al. J Pain Symptom Manage. 2000
The Take Home
Message
• Dyspnoea is a disabling and
subjective sensation of inability to
breathe
• Dyspnoea is common in all end stage
diseases
• Dyspnoea may cluster with other
symptoms such as pain and
numbness
• In cancer patients lung involvement
and anxiety are related to dyspnoea
Thank you