Chapter 27: Living with and beyond cancer
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Evidence‐based approaches
There is a robust evidence base for the beneficial effect and cost‐effectiveness of a multidisciplinary approach to the management of this complex symptom (Booth et al. [20], Higginson et al. [124]). Non‐pharmacological approaches may form a higher proportion of this management earlier in the disease trajectory, with pharmacological interventions playing an increasing role as the symptom advances (Higginson et al. [124]).
Rationale
Optimal management of breathlessness combines a sensory–nociceptive model (focusing on the causes due to the neural pathways and mechanisms that can be relieved by pharmacological interventions) and the biopsychosocial model (focusing on physical and behavioural modification and psychological intervention) to achieve an integrated approach where the individual's emotional experience of breathlessness is considered inseparable from its physical symptoms (Corner et al. [59]).
Diagnosis and treatment of underlying causes is the first approach to managing this symptom; however, despite optimal treatment, breathlessness persists in many patients and the use of non‐pharmacological approaches and a multidisciplinary approach is required (Booth et al. [19]). Optimal breathlessness management for each person may be achieved by a detailed assessment and a thorough understanding of the triggers of the episodes of breathlessness; a problem‐solving approach to managing the causative factors or triggers; and the management of the remaining symptoms with non‐pharmacological and pharmacological treatment.
Any possible solutions or treatments will be discussed and tested with the person and their carers for best effect, so that the person is able to manage the symptoms by themselves. Involvement of carers is important to empower both the person and their carer with techniques that may be effective. This will reduce anxiety for both parties as it will also improve the use of techniques in the situations triggering breathlessness and improve the ability to cope at home. This also gives the opportunity for both parties to discuss their own needs in managing this frightening symptom.
Indications
- When the assessment has demonstrated the causes and triggers that limit participation or activity for the patient and/or their carers.
- Where the assessment has indicated a lack of understanding, education or coping strategies to manage the symptom.
- Where the patient has indicated a willingness to try the procedures.
Contraindications
- Where there is no indication for the procedure.
- Where the person and family experience no benefit from the procedures.
- Where the person and family perceive it as burdensome.
