October 2002

Dear Readers: Here's the Article for this Month:

Name of article:

Prevalence and Screening of Dyspnea Interfering with Daily Life Activities in Ambulatory Patients with Advanced Lung Cancer

Author(s): Tanaka K, Akechi T, Okuyama T, Nishiwaki Y, Uchitomi Y

Reference: J Pain Symptom Management 2002; 23: 484-9

Abstract:

The authors carried out a study on 157 out-patients with advanced lung cancer not treated with anti-cancer treatments in the previous month.

The aims of the study were to identify:

a. the prevalence of "clinical dyspnea" defined as dyspnea interfering with any daily life activities (Interference Questionnaire)

b. the feature of the impact of dyspnea on daily life activities

c. the screening ability of the Cancer Dyspnea Scale (CDS) and the Dyspnea Numeric Scale (DNS)

d. the test-retest reliability of two assessment tools ( DNS and the Interference Questionnaire) performed on thirty-seven consecutive patients, selected from the entire patient sample.

CDS is an assessment tool previously developed to evaluate the multidimensional nature of dyspnea in cancer patients (Tanaka et al. Br J Cancer 2000; 82: 800-3).

By means of 5 levels of intensity of each item (1= not at all- 5= very much), the CDS evaluates the "sense of effort" (5 items), the "sense of anxiety" (4 items) and the "sense of discomfort" (3 items). The higher the score , the more severe is the patient’s dyspnea.

DNS is a numerical scale to evaluate global sensation of dyspnea ranging from 0 (no dyspnea) to 10 (dyspnea as bad as can be imagined).

Interference Questionnaire was performed to evaluate the presence or the absence of interference between dyspnea and physical and psychological daily life activity in the previous 24 hours.

The analysis of the data showed the validity and reliability of the DNS and the Interference Questionnaire. 55% of patients were suffering from clinical dyspnea which interfered with daily life activities. In 52% of patients dyspnea interfered with physical and in 23% with psychological domain.

Patients with clinical dyspnea had significantly higher CDS scores (p<0.001) and DNS score (p<0.001) than those without.

The ROC curve showed that both the DNS and the CDS are useful screening tools for clinical dyspnea.

The DNS is recommended as a screening tool because it is simple and easy to apply.

The prevalence of clinical dyspnea assessed by means of the specific tools, was higher than expected if we take into consideration that only 3% of the patients were treated with oxygen therapy. Furthermore, also patients whose dyspnea was considered "mild" reported interference with daily activities.

These results confirm that 1. there exists a discrepancy between respiratory function and the presence and intensity of clinical dyspnea, 2. the intensity of dyspnea is evaluated at rest as well as during daily activities and 3. it is not only "severe" dyspnea which interferes with activities.

Why I chose this Article:

Dyspnea is one of the most common symptoms in advanced cancer patients regardless of cancer site. There has been considerably less emphasis in the literature on the appropriate characterization and assessment of this symptom than of other cancer symptoms, and there is some evidence that the current palliative approach for dyspnea may be less effective than that for pain.

In clinical practice, it is evident that the assessment of the intensity of dyspnea by means of pulmonary function tests is inadequate in advanced cancer patients. Thus the assessment of the subjective sensation of the intensity of dyspnea at rest and during activities as well as the impact of dyspnea on quality of life by means of validated tools is paramount.

Regards,

Carla Ripamonti, MD
Member of the Board of Directors, IAHPC