2
Key Points
➤ Dyspnea is one of the most common and distressing symptoms
affecting patients with advanced cancer.
• In a meta-analysis that included over 10,000 patients with advanced cancer,
10%–70% of patients reported dyspnea.
a
➤ The burden of dyspnea is further compounded by other related
symptoms such as fatigue, anxiety, and depression, resulting in
functional limitation, compromised quality of life, and increased
informal (family) caregiver burden.
➤ In the advanced cancer setting, the presence of dyspnea, particularly
at rest, indicates a poor prognosis (typically less than a few months)
and has important clinical implications.
• First, a patient's prognosis could significantly impact recommendations regarding
assessments and treatments.
• Second, clinicians need to routinely engage in serious illness conversations with
the patients and their caregivers to ensure prognostic understanding, discuss
how dyspnea should be managed (e.g., cancer treatments, palliative options), and
support advance care planning.
a
Solano JP, Gomes B, Higginson IJ: A Comparison of Symptom Prevalence in Far Advanced Cancer,
AIDS, Heart Disease, Chronic Obstructive Pulmonary Disease and Renal Disease. Journal of Pain
and Symptom Management 31:58-69, 2006
Recommendation Grading
Type Benefit/harm Evidence Quality
Strength of
Recommendation
EB Evidence-based B Benefits
outweigh
harms
H High Strong
CB/
FC
Consensus-
based/Formal
Consensus
H Harms
outweigh
benefits
I Intermediate Moderate
IC Informal
consensus
B/H Relative
balance of
benefits
and
harms
L Low Weak
GPS Good Practice
Statement
U Benefits/
harms
ratio
uncertain
Ins Insufficient
