3
Treatment
1. Screening and Assessment
➤ Clinicians should perform systematic assessment of dyspnea at every
inpatient and outpatient encounter in patients with advanced cancer
using validated patient-reported outcome measures. (GPS)
➤ For patients who are unable to self-report, clinicians should use a
validated observation measure. (GPS)
➤ Whenever possible, patients with dyspnea should undergo a
comprehensive evaluation for the severity, chronicity, potential
causes, triggers, and associated symptoms, as well as emotional and
functional impact. (GPS)
Note: Examples of validated and easy-to-use assessment tools are provided in the
Supplement.
2. Treatment of Underlying Causes
➤ Patients with potentially reversible, common etiologies of dyspnea
such as pleural effusion, pneumonia, airway obstruction, anemia,
asthma, chronic obstructive pulmonary disease (COPD) exacerbation,
pulmonary embolism, or treatment-induced pneumonitis should be
given goal-concordant treatment(s) consistent with their wishes,
prognosis, and overall health status. (GPS)
➤ Patients with dyspnea due to underlying malignancy (e.g.,
lymphangitic carcinomatosis, atelectasis due to large pulmonary
mass, malignant pleural effusion) may benefit from cancer-directed
treatments if consistent with their wishes, prognosis, and overall
health status. (GPS)
➤ Patients with underlying co-morbidities such as COPD or heart failure
should have the management of these conditions optimized. (GPS)
3. Referral to Palliative Care
➤ Patients with advanced cancer and dyspnea should be referred to
an interprofessional palliative care team where available. (Strong
recommendation; EB-I)
