[Palliation of dyspnea in malignant disease]

Dyspnea is a symptom experienced by more than half of all cancer patients in their terminal illness, and it is thus a severe problem for patients, relatives, and professionals. Dyspnea in a cancer patient may have a non-malignant origin that may be treated causally. If dyspnea is caused directly by the malignant disease, antineoplastic treatment needs to be considered. In case this is not feasible, one must seek to modify the manifestations of illness. When this is not possible, one must relieve the patient's experience of dyspnea. To this end there are a number of possibilities, pharmacological as well as non-pharmacological. Opioids given systemically cause respiratory depression. Unfortunately, this has given rise to an overly cautious attitude when facing the terminal patient with dyspnea. However, other treatment modalities are often exhausted and opioids, if indicated in combination with anxiolytics, do have a palliative effect on dyspnea.