Zusammenfassung
Die Prävalenz von Dyspnoe bei Tumorpatienten im fortgeschrittenen Stadium bewegt sich von 19 % bis 64 %. Um Dyspnoe bei Tumorpatienten adäquat zu behandeln, ist es notwendig, die genauen Mechanismen der Dyspnoe zu kennen. Auch die genaue Diagnosestellung kann wesentliches zur Therapieentscheidung beitragen. Klinisch sollten daher alle zu Grunde liegenden Möglichkeiten für Dyspnoe bei Tumorpatienten abgeklärt werden. Detailliertes Wissen über die mannigfaltigen Ursachen von Dyspnoe ist zwingend notwendig. Anamneseerhebung, physikalische Untersuchung und andere ausgewählte Untersuchungen sollten rasch durchgeführt werden, um schnell zu einer therapeutischen Entscheidung kommen zu können. Das Abschätzen der Quantität und der Qualität der Dyspnoe können ebenfalls dazu beitragen, die Bedürfnisse der Patienten so schnell wie möglich zu erfassen.
Summary
The reported prevalence of dyspnea in patients with various cancers ranges from 19% to 64%. For optimal clinical management of dyspnea in cancer patients, accurate diagnosis of the underlying cause and thorough understanding of the pathomechanisms of dyspnea seems mandatory. The clinical approach to a patient with advanced cancer and dyspnea should include adequate history taking, physical examination, and selected diagnostic investigations. These should be performed immediately to enable quick treatment decisions. In addition, self assessment of the intensity of dyspnea by the patient may help to assess patient's needs as soon as possible.
References
Ripamonti C, Fusco F. Respiratory problems in advanced cancer. Support Care Cancer, 10: 204–216, 2002
Dyspnea. Mechanisms, assessment, and management: a consensus statement. American Thoracic Society. Am J Respir Crit Care Med, 159: 321–340, 1999
Thomas JR, Von Gunten CF. Management of dyspnea. J Support Oncol, 1: 23–32, 2003
Thomas JR, Von Gunten CF. Clinical management of dyspnoea. Lancet Oncol, 3: 223–228, 2002
Ripamonti C, Bruera E. Dyspnea: pathophysiology and assessment. J Pain Symptom Manage, 13: 220–232, 1997
Davis CL. ABC of palliative care. Breathlessness, cough, and other respiratory problems. BMJ, 315: 931–934, 1997
Lanken PN, Terry PB, Delisser HM, Fahy BF, Hansen-Flaschen J, Heffner JE, Levy M, Mularski RA, Osborne ML, Prendergast TJ, Rocker G, Sibbald WJ, Wilfond B, Yankaskas JR. An official American Thoracic Society clinical policy statement: palliative care for patients with respiratory diseases and critical illnesses. Am J Respir Crit Care Med, 177: 912–927, 2008
Ripamonti C. Management of dyspnea in advanced cancer patients. Support Care Cancer, 7: 233–243, 1999
Claessens MT, Lynn J, Zhong Z, Desbiens NA, Phillips RS, Wu AW, Harrell FE Jr, Connors AF Jr. Dying with lung cancer or chronic obstructive pulmonary disease: insights from SUPPORT. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. J Am Geriatr Soc, 48: S146–S153, 2000
Greenberg B, McCorkle R, Vlahov D, Selwyn PA. Palliative care for HIV disease in the era of highly active antiretroviral therapy. J Urban Health, 77: 150–165, 2000
McCarthy M, Lay M, Addington-Hall J. Dying from heart disease. J R Coll Physicians Lond, 30: 325–328, 1996
Voltz R, Borasio GD. Palliative therapy in the terminal stage of neurological disease. J Neurol, 244(Suppl 4): S2–S10, 1997
Reuben DB, Mor V. Dyspnea in terminally ill cancer patients. Chest, 89: 234–236, 1986
Bruera E, Schmitz B, Pither J, Neumann CM, Hanson J. The frequency and correlates of dyspnea in patients with advanced cancer. J Pain Symptom Manage, 19: 357–362, 2000
Curtis EB, Krech R, Walsh TD. Common symptoms in patients with advanced cancer. J Palliat Care, 7: 25–29, 1991
Dudgeon DJ, Kristjanson L, Sloan JA, Lertzman M, Clement K. Dyspnea in cancer patients: prevalence and associated factors. J Pain Symptom Manage, 21: 95–102, 2001
Chan KS, Sham MMK, Tse DMW, Thorsen AB. Palliative medicine in malignant respiratory diseases. 3rd ed. pp 587–618, 2005
Higginson I, McCarthy M. Measuring symptoms in terminal cancer: are pain and dyspnoea controlled? J R Soc Med, 82: 264–267, 1989
Conill C, Verger E, Henriquez I, Saiz N, Espier M, Lugo F, Garrigos A. Symptom prevalence in the last week of life. J Pain Symptom Manage, 14: 328–331, 1997
Mercadante S, Casuccio A, Fulfaro F. The course of symptom frequency and intensity in advanced cancer patients followed at home. J Pain Symptom Manage, 20: 104–112, 2000
Brown ML, Carrieri V, Janson-Bjerklie, Dodd MJ. Lung cancer and dyspnea: the patient's perception. Oncol Nurs Forum, 13: 19–24, 1986
Roberts DK, Thorne SE, Pearson C. The experience of dyspnea in late-stage cancer. Patients' and nurses' perspectives. Cancer Nurs, 16: 310–320, 1993
O'Driscoll M, Corner J, Bailey C. The experience of breathlessness in lung cancer. Eur J Cancer Care (Engl), 8: 37–43, 1999
Dodd M, Janson S, Facione N, Faucett J, Froelicher ES, Humphreys J, Lee K, Miaskowski C, Puntillo K, Rankin S, Taylor D. Advancing the science of symptom management. J Adv Nurs, 33: 668–676, 2001
Mancini I, Body JJ. Assessment of dyspnea in advanced cancer patients. Support Care Cancer, 7: 229–232, 1999
Bausewein C, Farquhar M, Booth S, Gysels M, Higginson IJ. Measurement of breathlessness in advanced disease: a systematic review. Respir Med, 101: 399–410, 2007
Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc, 14: 377–381, 1982
Kendrick KR, Baxi SC, Smith RM. Usefulness of the modified 0–10 Borg scale in assessing the degree of dyspnea in patients with COPD and asthma. J Emerg Nurs, 26: 216–222, 2000
Chiu TY, Hu WY, Lue BH, Yao CA, Chen CY, Wakai S. Dyspnea and its correlates in taiwanese patients with terminal cancer. J Pain Symptom Manage, 28: 123–132, 2004
Tanaka K, Akechi T, Okuyama T, Nishiwaki Y, Uchitomi Y. Development and validation of the Cancer Dyspnoea Scale: a multidimensional, brief, self-rating scale. Br J Cancer, 82: 800–805, 2000
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Pohl, G., Gaertner, J. Pathophysiology and diagnosis of dyspnea in patients with advanced cancer. Wien Med Wochenschr 159, 571–576 (2009). https://doi.org/10.1007/s10354-009-0725-1
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DOI: https://doi.org/10.1007/s10354-009-0725-1