Does Patient-reported Dyspnea Reflect Thoracic Disease Characteristics in Patients with Incurable Cancer?

A considerable proportion of patients with incurable cancer experience dyspnea. This study evaluates associations between the feeling of dyspnea, as quantified by radiotherapy patients scoring their symptoms before palliative treatment with the Edmonton symptom assessment system (ESAS), and potential underlying causes.

Retrospective comparison of the incidence of different parameters that could cause a feeling of dyspnea in two groups, patients with no or minimal dyspnea (ESAS score 0-2) and those with dyspnea scores >2.

The mean dyspnea score of all 102 patients was 2.6. Dyspnea scores >2 were present in 68% of patients with lung cancer, 50% of those with breast cancer, 39% of those with prostate cancer and 26% of those with other tumors (p=0.025). Dyspnea scores >2 were also present in 69% of patients with pleural effusion (vs. 40% in patients without pleural effusion), p=0.031. Among patients treated with palliative thoracic radiotherapy, 71% had dyspnea scores >2 (40% if other targets were irradiated), p=0.041. In 13% of patients, anemia and pulmonary comorbidity were the most likely explanation for dyspnea. In 29% the feeling of dyspnea could not be related to objective findings.

In the majority of patients, the feeling of dyspnea was associated with the presence of thoracic metastases with or without pleural effusion from extrathoracic primary tumors or with a lung cancer diagnosis. A substantial proportion of patients reported dyspnea that could be related neither to cancer burden nor comorbidity.