Chapter 27: Living with and beyond cancer
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Assessment and recording tools
A dual approach to measurement of the effect of the intervention and recording should be taken to capture the magnitude and impact of the sensation of breathlessness for the individual. An objective measure of how the breathlessness felt to the patient before and after the intervention in response to a simple question ‘How does it make you feel when you are breathless?’ should be used. The sensation of breathlessness can be quantified using a measurement scale, for example a visual analogue scale (Adams et al. [4]), the modified Borg ([22]) scale (see Section c27-sec-0267, Physical activity for people with cancer) or a numerical rating scale as shown in Figure 27.25 (Gift and Narsavage [112], Guyatt et al. [120]).
Figure 27.25 Numerical rating scale.
Non‐pharmacological support
Functioning
Refer to a physiotherapist for consideration of a course of pulmonary rehabilitation to educate and to manage breathlessness caused by deconditioning. These courses often include strategies that promote functioning. These strategies should all be considered even if a course is not accessible.
The strategies include:
- Testing any benefit from appropriate walking aids to increase the patient's base of support. Offer a resting place during the activity (e.g. wheeled walker or a gutter rollator) (Booth et al. [19], Pryor and Prasad [230]).
- Assessing the influence of environmental factors (e.g. set‐up of home situation, poor sleep hygiene or poor pacing of activities; see Sections c27-sec-0267, Physical activity for people with cancer and c27-sec-0291, Cancer‐related fatigue and sleep).
- Assessing nutritional status and energy requirements. Nutritional supplements should be provided if needed (see Section c27-sec-0131, Nutritional status).
- Teaching resting positions that improve the mechanics of breathing and lower the required energy expenditure (Figure 27.26).
Figure 27.26 The five recommended resting positions. Source: Dougherty and Lister ([91]).
Breathing
Refer to a physiotherapist or a trained respiratory nurse for education about the causes of breathlessness, breathing control, breathlessness management and advice for optimal positioning at rest and during activity. Physiotherapists may also give advice on airway clearance and cough techniques as well as specific inspiratory muscle training (Booth et al. [19], Pryor and Prasad [230]).
A handheld fan (Figure 27.27) with the draft directed to the face reduces the sense of breathlessness. It can be introduced to the patient and tested for effect as set out in Procedure guideline 27.18 (Galbraith et al. [109]).
Procedure guideline 27.18
Breathlessness management: using a handheld fan
Figure 27.27 A handheld fan.
Thinking
To moderate the effect of thinking or emotion on the neural respiratory drive, it is important to identify any related triggers and educate about breathlessness triggered by anxiety. Management of these psychological triggers may be supported by referral to other therapies to develop and use coping strategies. These strategies may include education about the relationship between emotions and breathlessness; cognitive behavioural therapy; mindfulness; self‐hypnosis; visual aids; acupuncture or acupressure; aromatherapy massage; or referral to learn relaxation (see Procedure guideline 27.19) (Booth et al. [19], Dyer et al. [95], Powell [229], Thomas et al. [269]).
Rationale
To reduce the effect of the symptoms of breathlessness, patients may be offered individually chosen aroma stick inhalers as part of the care offered by complementary therapists.
Indications
When a patient has reported that their breathlessness has been eased during the aromatherapy massage sessions.
Equipment
It is an individual plastic inhaler device. The inner wick is blank/unscented, permitting the addition of essential oils (Dyer et al. [95]). The wick absorbs the essential oils (up to 20 drops are applied); the device is then sealed and can be used until there is no longer a smell (Figure 27.28).
Procedure guideline 27.19
Breathlessness management: essential oil administration via an aroma stick inhaler
Figure 27.28 Parts of an aroma stick inhaler.
