DYSPNEA IN CANCER-PATIENTS - ETIOLOGY, RESOURCE UTILIZATION, AND SURVIVAL-IMPLICATIONS IN A MANAGED CARE WORLD

BACKGROUND. Dyspnea is the fourth most common symptom of patients who present to the emergency department (ED) at The University of Texas M. D. Anderson Cancer Center and may, in some patients with advanced canc er, represent a clinical marker for the terminal phase of their diseas e. This retrospective study describes the clinical characteristics of these patients, the resource utilization associated with the managemen t of dyspnea, and the survival of patients with this symptom. METHODS. The authors randomly selected 122 of 1068 patients presenting with dy spnea for a retrospective analysis. The median age of the patients was 58 years (range, 23-90 years) and 53% were female. Underlying maligna ncies were breast cancer (30%), lung cancer (37%), and other cancers ( 34%). Approximately 94% of the patients had received prior cancer trea tment and the majority (69%) had uncontrolled, progressive disease. RE SULTS. The most common treatments administered in the ED were oxygen ( 31%), beta-2 agonists (14%), antibiotics (12%), and narcotics (11%). A pproximately 60% of patients were admitted to the hospital from the ED for further treatment of dyspnea and the underlying malignancy, and t he median length of stay was 9 days. The median overall survival after the ED visit for dyspnea was 12 weeks. Specific diagnoses were associ ated with different median survival rates: lung cancer patients: 4 wee ks; breast cancer patients: 22 weeks (P = 0.0073, vs. lung cancer); an d other cancer diagnoses: 27 weeks (P = 0.0027, vs. lung cancer). CONC LUSIONS. Lung cancer patients presenting to the ED with dyspnea have m uch shorter survival than patients with other malignancies. For some p atients, the presence of dyspnea requiring emergency treatment may ind icate a phase in their illness in which resources should be shifted fr om acute intervention with hospitalization to palliative and supportiv e care measures. (C) 1996 American Cancer Society.