New trial published in the Lancet Respiratory Medicine provides evidence for early integration of palliative care in patients with advanced disease suffering from breathlessness.
Higginson and colleagues randomised 105 people with advanced disease and refractory breathlessness (MRC dyspnoea scale score >2) to receive a breathlessness support service or usual care. The breathlessness support service involved, sequentially: 1) An outpatient clinic appointment involving assessment and treatment by respiratory medicine and palliative care clinicians, as well as a breathlessness information and management pack; 2) An allied health home assessment and promotion of self-management techniques approximately 2-3 weeks post the clinic; and 3) A final discharge planning outpatient clinic appointment with a palliative care clinician approximately 4 weeks post the clinic.
Mastery of breathlessness symptoms significantly improved for patients attending the breathlessness support service, compared to usual care (16% improvement, p=0.048). For patients with COPD and interstitial lung disease (but not cancer): survival rate from randomisation to 6 months was greater in those who attended the breathlessness support service (94%) versus usual care (75%), as was overall survival (p=0.048). Total health care costs calculated from patient-reported health service use were not significantly different between groups.
Higginson IJ, Bausewein C, Reilly CC, Gao W, Gysels M, Dzingina M et al. An integrated palliative and respiratory care service for patients with advanced disease and refractory breathlessness: a randomised controlled trial. The Lancet Respiratory Medicine. 2014. 2(12):979-987. DOI: 10.1016/S2213-2600(14)70226-7