Prevalence of Dyspnea
Points to Ponder
- Prevalence ranges from 20 to 60% of all cancer patients.
- Dyspnea is much more prevalent in end stage heart (Anderson 2001) and lung diseases for patients in their final years.
- Many HIV positive patients suffer from dyspnea (owing to comorbid conditions like Pneumocystis Carinii pneumonia, Kaposi’s sarcoma with lung infiltration, tuberculosis etc.)
- Dyspnea tends to become more severe and more frequent toward the end of life (Ripamonti 1999) (Higginson 1989) (Conill 1997).
- Prevalence and intensity increase with lung, pleural and mediastinal involvements in cancer patients (Reuben 1986) (Dudgeon 2001).
- Low functional status (Karnofsky Performance Scale) is associated with an increase in severity and incidence of dyspnea (Reuben 1986) (Chang 2000) (Mercadante 2000).
- Dyspnea is often unreported by patients and unnoticed by healthcare professionals (Roberts 1993) (Kutner 2001).
Evidence of Dyspnea by Disease
|Ripamonti||Medline Search 1966-1999||—||21-79%||10-63% moderate-severe increase frequency and severity when close to death, different causes may coexist.|
|Higginson||Community||86||21%||became the most severe symptom at death|
|Reuben||National hospice study||1754||50%||Incidence 70%, significantly associated with lung & pleura tumor involvement, lowKarnofsky Performance Scale, and underlying lung disease. Lung, colorectal, and breast carcinomas are the most common tumor sites.|
|Grond||Pain clinic||1635||24%||Pain plus 3.3 symptoms on average.|
|Muers||Specialist clinic||289||60%||NSCLC, symptom worsened with time.|
|Donnelly||Palliative care consult||1000||28%||Advanced cancers, moderate to severe in 63%.|
|Chang||VA In/outpatients||240||50%||Median # of symptoms 8, # of intense symptoms increased as Karnofsky Performance Scale decreased. Disease free patients may still experience intense symptoms.|
|Dudgeon||Outpatient||923||46%||General cancer, 4% lung cancer, 5.4% lung mets.|
|Potter||Palliative care referral||400||31%||95% of patients were with cancer.|
|Conill||Home and inpatients||176||40%||Increased to 46% in the last week of life.|
|Bruera||Pain clinic||135||55%*||Lung involvement and anxiety were independently correlated with intensity of dyspnea. (* Moderate).|
|Edmonds||Post bereavement interview||449||78%||Lung cancer.|
|Claessens||Five academic centers||939||32%*||NSCLC (* Severe).|
|Edmonds||Post bereavement interview||87||94%||Chronic lung disease, dyspnea increased in final year and final weeks.|
|Claessens||Five academic centers||1008||56% *||COPD (* Severe).|
|Nordgren||Review of hospitalized||80||men 90%, women 86%||Last 6 months of life CHF patients.|
|Fantoni||Inpatient and outpatients||266||68%||Last 3 months of life.|
|Diaz||Academic medical center||327||41%||Positive HIV without AIDS.|
|General Home Hospice Population|
|Syrett||St. Christopher’s home||470||43%||Home hospice audit.|
|Ho||General patients at home||500||32%||Community-based study in South Wales.|