Assessment of dyspnea in advanced cancer patients

Dyspnea, which has been defined as an "umcomfortable awareness of breathing ," is a frequent and devastating symptom in advanced cancer patients. It ha s been reported to occur in 21-79% of patients evaluated a few days or week s before death. In advanced cancer, the aim of effective management is to m inimize the patient's perception of breathlessness, which depends in turn o n a reliable assessment. Unfortunately, most of our knowledge and experienc e of dyspnea has been acquired through working with patients with chronic p ulmonary disease, and there is a dearth of literature relating specifically to the assessment of dyspnea in advanced cancer. Dyspnea is a complex sens ation including several dimensions, such as antecedents (physiological and psychological events or stimuli preceding the development of dyspnea), medi ators (characteristics of individuals or their environment affecting the re sponse), reactions to dyspnea, and consequences or outcomes that result onc e the individual has reacted to a stimulus. The literature gives us many to ols to measure these aspects. For example, antecedents may be assessed by t he British Medical Research Council Questionnaire, the American Thoracic Qu estionnaire (ATS-DLD-78) and the Dyspnea Interview Schedule. Mediators of d yspnea may be measured by the ATS-DLD-78, the Chronic Respiratory Questionn aire (CRQ), the Dyspnea Interview Schedule, the Pulmonary Functional Status Scale (PFSS) and the Therapy Impact Questionnaire (TIQ). Reactions to dysp nea may be assessed by the Dyspnea Visual Analogue Scale (DVAS), the TIQ an d the Borg Scale, and the consequences of it by the TIQ, the Baseline Dyspn ea Index (BDI), the Transition Dyspnea Index (TDI), and CRQ, and by the Oxy gen Cost Diagram (OCD), the Dyspnea Interview Schedule and the Modified Med ical Research Council Dyspnea Scale (MRC). No single assessment tool consid ers all the different components of dyspnea,and the final choice will depen d on the purpose of the assessment, taking into account that the provision of quality of life is of paramount importance to patients who have limited time left to them and that the assessment should not therefore detract from the quality of life by being overlong, complicated or invasive.