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

Using bisphosphonates to control the pain of bone metastases: evidence-based guidelines for palliative care.

This work was undertaken by the Science Committee of the Association for Palliative Medicine of Great Britain and Ireland (APM) as a demonstration project in developing clinical guidelines relevant to palliative care from a pragmatic approach to literature review and grading of clinical evidence. CANCERLIT and Embase were searched for relevant papers written in English, published since 1980. Each study identified was rated against agreed criteria for levels of evidence. Most studies were not specifically designed to define speed of response, and were not undertaken in palliative care patients. Thus, careful reading and grading of each study was necessary. Sufficient evidence was identified to make recommendations for clinical practice in a palliative care population of patients, and areas for future research have been identified. Bisphosphonates appear to have a role in managing pain from metastases which has been refractory to conventional analgesic management and where oncological or orthopaedic intervention is delayed or inappropriate

Palliative care in chronic obstructive airways disease: a needs assessment

The view that palliative care should move beyond cancer is widely endorsed, however, there remains a lack of clarity about the level at which this should occur. In order to target the palliative approach effectively, the value of more detailed and localized needs assessment becomes apparent. This paper provides evidence from a study commissioned by a department of public health, where the focus was the palliative care needs of an individual with chronic obstructive airways disease (COAD). Over a six-month period, 63 individuals in the district were interviewed about their experiences of living with COAD and the services utilized, using a combination of qualitative and quantitative research methods. The findings revealed a poor quality of life, relating to a high degree of social isolation and emotional distress, associated with low physical functioning and disability, and physical symptoms. Current service provision focused on acute exacerbations. Consequently, there is a need to manage the health and social care interface more effectively, with a shift in emphasis from reactive ad hoc provision, which is where the palliative approach to care could be best suited to meet the needs identified