Refractory breathlessness is defined as breathlessness at rest or on minimal exertion that persists despite optimal treatment of the underlying cause(s). Such breathlessness is a very common symptom in patients affected by lung cancer, at diagnosis, during treatment, in survivorship (after radiotherapy, chemotherapy or surgery) and in advanced cancer, occurring in between 60% of patients at diagnosis and 90% of those with advanced disease.
Patients and carers experience a high level of distress from this frightening symptom. It is a frequent cause of hospital admission. Recent research has show that breathlessness often follows a fluctuant course, even in cancer patients. In addition, episodic or crisis breathlessness can be especially difficult to control.
Breathlessness remains a difficult symptom to improve despite recent advances in cancer treatment. Its causes are multifactorial, and may relate to pathology in the lung, but also muscle weakness, especially of the legs with deconditioning, weight gain, anaemia or electrolyte disturbance. In patients with lung cancer underlying COPD may go undetected and treated, which becomes more problematic after cancer treatment. This presentation will review recent advances in pharmacological and non-pharmacological treatments, and new service developments to support patients with breathlessness, such as an integrated respiratory / palliative breathlessness support service.