Monday 12 April 1999
The first multi-centre trial to find an effective treatment for breathlessness in lung cancer patients has been carried out by nurses at the Institute of Cancer Research. Although breathlessness is a major symptom of the disease affecting 70 per cent of sufferers, this nurse-led trial is the first piece of major research to look for a solution. (BMJ, Volume 318)
Lung cancer is the most common cancer in Britain with over 42,000 new cases diagnosed each year. Breathlessness is a major symptom of the disease - some 29,000 people are affected by it, and it has a dramatic impact on the lives of sufferers, making everyday tasks such as walking up stairs impossible, and causing fear and depression.
Despite these facts, current treatment of breathlessness is ineffective, and patients may receive little or no advice on how to cope with the symptom.
The trial, which was funded by UK cancer charity Macmillan Cancer Relief and led by Europe's first Professor of Cancer Nursing, Jessica Corner, of the Institute of Cancer Research, showed very promising results. The trial was carried out from the Macmillan Practice Development Unit at the Institute, and showed that for those patients who received nurse intervention compared with those who received standard care:
- There was a significant improvement in patients' breathlessness, levels of depression and physical symptoms.
- Patients' ability to carry out the everyday activities of climbing stairs, walking out of doors and going shopping was significantly improved.
- Patients' levels of anxiety and distress due to their breathlessness also showed a slight improvement.
Professor Jessica Corner says: "Breathlessness is a severe symptom of lung cancer and has a huge impact on the quality of life of people with the disease. During the trial, patients reported that they could not manage the most basic of everyday tasks and that they were in fear for their lives, feeling that they would never be able to get their breath.
Current treatment of breathlessness using opiates and steroids is only addressing half the problem. It does not take into consideration the emotional component, or how people respond physically to breathing problems."
The trial shows that a range of techniques offered by nurses can significantly improve these symptoms and patients' ability to deal with them. The findings could have a major impact on the lives of tens of thousands of people with lung cancer in the UK.
The techniques used in the trial included:
- A detailed assessment of patients' breathlessness and factors that ameliorate or exacerbate it
- Advice and support for patients and their families on ways of managing breathlessness
- Training in breathing control techniques, progressive muscle relaxation and distraction exercises.
This treatment has been developed and used by the team of Macmillan nurse researchers at the Institute of Cancer Research for several years to help patients cope with breathlessness, which is common in many cancer patients - over 30% of people admitted to hospices. But this trial is the first to analyse it and demonstrate that it works in centres throughout the UK.
"The problem is that so far the focus has been on cancer and pain, for which there has been a lot of research, but other symptoms such as breathlessness have been forgotten," adds Professor Corner.
119 patients were involved in the trial over an eight week period in six UK hospitals where clinics were led by specialist cancer nurses including Macmillan nurses. The patients had all been diagnosed with small cell or non-small cell lung cancer or mesothelioma, had completed first line treatment for their disease, and reported breathlessness.
Patients who received the intervention were treated in a nurse-led clinic while the control group was given standard care and patients also had their breathlessness and its effects on their life monitored.
Results for the control group typically showed that patients who were able to care for themselves and be up for 50% of waking hours at the start of the trial had deteriorated after eight weeks. This was to a point where they were confined to bed, could not care for themselves and were effectively completely disabled. In contrast patients who received the intervention typically maintained their ability to care for themselves.
Professor Corner adds: "The next step is to look at ways in which this treatment could be introduced nationally. Our research also shows that clinics offering these interventions can easily be introduced into hospital settings by specialist nurses as they were in the centres where the trial took place. However, if this approach is to be introduced nationally, to alleviate the suffering of lung cancer patients suffering breathlessness, more nurses will need to be specially trained to give this treatment."
Dr Peter Rigby, Chief Executive of the Institute of Cancer Research, comments: "This is a very significant piece of research, and has been shown to be of great benefit to patients. The treatment is also cost effective because four hours of a nurse's time with a patient produces results in a matter of weeks."
- ends -
Notes to Editors:
- Patients' experience of breathlessness was assessed using a number of techniques including visual analogue scales measuring breathlessness at worst and best and distress due to breathlessness, the WHO performance scale, the hospital anxiety and depression scale and the Rotterdam symptom checklist.
- Data was collected from patients in both the intervention and control groups after the first, fourth and eighth weeks.
For further information please contact The Press Office on:-
Tel: 0207 970 6030
email: [email protected]
Please note:
Unfortunately the press office are unable to answer queries from the general public. For general cancer information please refer to The Institute's cancer information page.