Dyspnea in Advanced Cancer: 'Dying Long Before Death'

More than half of patients with advanced cancer have difficulty breathing, and this chronic dyspnea can be highly debilitating and challenging to manage, thanks to the lack of evidence-based treatment options or a standard of care.

Dyspnea is prevalent in 50% to 60% of patients with advanced cancer generally and in up to 74% of patients with lung cancer. Prevalence increases during the last 6 weeks of life and can cause significant psychological and emotional distress, they noted.
Many patients report feelings of suffocation or "air hunger,” while others describe a choking sensation or chest tightness that makes breathing difficult and exhausting. Chronic refractory dyspnea can lead to overwhelming feelings of helplessness, anxiety, and depression.

The social isolation that comes with breathlessness can be equally traumatic, said David C. Currow, MD, professor of palliative and supportive services at Flinders University in Adelaide, South Australia.

People describe dying a social death long before they die a physical death. Dr David Currow

“People describe dying a social death long before they die a physical death,” he commented in an interview. "Their symptoms are progressively worsening, their exercise tolerance is decreasing, and their friends aren't coming around anymore because breathlessness is very difficult to watch."

Even in the general population, dyspnea may be more prevalent than previously thought. In Australia, population studies independent of health service access revealed that 1 in 100 people had severe chronic breathlessness on a day-to-day basis, and 1 in 300 people had breathlessness so severe that it precluded them from leaving the house.