Point prevalence of dyspnea, quality, and effect of Dyspnea management in ambulatory patients with advanced cancer: A Multi-center Study

Background and rationale: Dyspnea is defined as “an uncomfortable sensation of breathing†(1). It is one of the most common symptoms in advanced cancer patients, regardless of cancer site. In a previous study in our center, we found that prevalence of dyspnea in advanced cancers is 44.37% (2). It is very distressing for the patient as well as the caregivers and is difficult to manage. These patients with advanced cancers may suffer from refractory dyspnea, which is associated with other symptoms and psycho-social concerns (3). Hence it is important to use a multi-dimensional tool for assessment of dyspnea in such patients. Management of dyspnea involves multimodal nonpharmacological and pharmacological treatments. One of the commonly used drugs to manage refractory dyspnea is Morphine sulfate (4). It modulates the perception of dyspnea by binding to opioid receptors. Proposed mechanisms whereby opioids relieve refractory dyspnea include: decreasing respiratory drive with an associated decrease in corollary discharge; altering central perception; altering activity of peripheral opioid receptors located in the lung and decreasing anxiety (5). The clinical prevalence, quality and management of dyspnea varies in the country, and there is little literature on this aspect (6). It is thus worthwhile to investigate this in a multicentric trial.

Aims: The aim of this study is to know the clinical prevalence, quality of dyspnea, use of opioids in the management of dyspnea in advanced cancer patients in multiple centers in India and to look at the effect of dyspnea management on the Quality of Life of these patients. Objectives Primary objective Screen for clinical dyspnea as shown on a 10-cm visual analog scale and identify the clinical prevalence of dyspnea Secondary objectives 1. Identify the quality of dyspnea by Cancer Dyspnea Scale (CDS) 2. To identify the effect o dyspnea management on daily life activities and Quality of Life of patients. 3. To record the dosage* of opioids/ 24 hours used to manage refractory dyspnea$ in Oral Morphine Equivalents (OME) and changes in VAS-D at 1, 3, and 7 days. *if opioids are used for pain, then the additional amount of opioid required to manage dyspnea is to be noted. $ refractory dyspnea is breathing difficulty that persists at rest or with minimal activity despite optimal therapy of the underlying condition (5)

Longitudinal study

Prospective observational multi centric study. Tata Memorial Hospital, Mumbai will be the coordinating center. The other participating sites invited for this study are Palliative Medicine Departments of: 1. Acharya Harihar Regional Cancer Centre, Cuttack 2. Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam 3. Shri Siddhivinayak Ganapati Cancer Hospital, Miraj 4. All India Institute of Medical Sciences, Delhi 5. The Gujarat Cancer & Research Institute, Ahmedabad