Management of breathlessness in patients with cancer: ESMO Clinical Practice Guidelines

Care of the adult cancer patient at the end of life: ESMO Clinical Practice Guidelines

“…modified Medical Research Council (mMRC) breathlessness scale]. 63 Principles of treatment. For dyspnoea, the initial focus should be on optimising treatment of a patient's underlying disease.…”

“…Non-pharmacological treatment could provide short-term benefit but at EoL this may not be tolerated. 63 Choice of medication. Most of the evidence comes from studies in chronic obstructive pulmonary disease (COPD) patients.…”

“…According to the ESMO CPG on breathlessness, preferred treatment of the relief of chronic refractory breathlessness is a systemic, oral or parenteral low-dose opioid that reduces mean chronic breathlessness by w20% over baseline with no evidence of significant or clinically-relevant respiratory adverse effects. 63 In opioid-tolerant patients, an increase in baseline dose of opioid by 25%-50% may be considered. 63 A larger confirmatory randomised trial is currently under way to examine the effect of dexamethasone on breathlessness in cancer patients (clinicaltrials.gov NCT03367156).…”

“…63 In opioid-tolerant patients, an increase in baseline dose of opioid by 25%-50% may be considered. 63 A larger confirmatory randomised trial is currently under way to examine the effect of dexamethasone on breathlessness in cancer patients (clinicaltrials.gov NCT03367156). 63 Benzodiazepines are frequently used when breathlessness is associated with anxiety.…”

“…It is highly prevalent, affecting between 20% and 70% of cancer patients and is associated with poor prognosis. 63 The evaluation of breathlessness should identify all contributing causes that are amenable to treatment. The gold standard for breathlessness assessment is based on patient self-report at rest and on moving.…”