Breathlessness, Functional Status, Distress, and Palliative Care Needs Over Time in Patients With Advanced Chronic Obstructive Pulmonary Disease or Lung Cancer: A Cohort Study  Vera Weingaertner, Dipl Ges Oek, Christine Scheve, Dipl Pflegew, Verena Gerdes, Dipl Päd, Michael Schwarz-Eywill, MD, Regina Prenzel, MD, Claudia Bausewein, PhD, MD, MSc, Irene J. Higginson, BM, BS, BMedSci, PhD, FFPHM, FRCP, Raymond Voltz, MD, Lena Herich, Dr Rer Pol, Steffen T. Simon, MD, MSc Birgit Kannenberg-Otremba, Nicole Sowinsky, Burkhard Otremba, Alexander Jüptner, Jochen Meyer, Julia Cortis, Juliane Mühlenbrock, Andreas Wagner-Neidig, Andreas Hein, Dietmar Reichert, Marion Jessen, Melina Frenken, Thomas Frenken Vera Weingaertner, Dipl Ges Oek, Christine Scheve, Dipl Pflegew, Verena Gerdes, Dipl Päd, Michael Schwarz-Eywill, MD, Regina Prenzel, MD, Claudia Bausewein, PhD, MD, MSc, Irene J. Higginson, BM, BS, BMedSci, PhD, FFPHM, FRCP, Raymond Voltz, MD, Lena Herich, Dr Rer Pol, Steffen T. Simon, MD, MSc Birgit Kannenberg-Otremba, Nicole Sowinsky, Burkhard Otremba, Alexander Jüptner, Jochen Meyer, Julia Cortis, Juliane Mühlenbrock, Andreas Wagner-Neidig, Andreas Hein, Dietmar Reichert, Marion Jessen, Melina Frenken, Thomas Frenken  Journal of Pain and Symptom Management  Volume 48, Issue 4, Pages 569-581.e1 (October 2014) DOI: 10.1016/j.jpainsymman.2013.11.011 Copyright © 2014 American Academy of Hospice and Palliative Medicine Terms and Conditions

Fig. 1 Forward trajectories of breathlessness severity, functional status, distress, and PC needs in COPD and LC patients. The graph shows the means and 95% CIs of breathlessness severity (modified Borg scale) (a), distress (NCCN DT) (b), functional status (KPS transformed) (c) and PC needs (POS sum score transformed) (d), by disease group over time at each follow-up assessment. In the table, for both disease groups the numbers of patients, the means (bold) and SDs for each outcome are presented per follow-up assessment. COPD=chronic obstructive pulmonary disease; LC=lung cancer; CI=confidence interval; KPS=Karnofsky Performance Status Scale; NCCN DT=National Comprehensive Cancer Network Distress Thermometer; PC=Palliative Care, POS=Palliative care Outcome Scale. Journal of Pain and Symptom Management 2014 48, 569-581.e1DOI: (10.1016/j.jpainsymman.2013.11.011) Copyright © 2014 American Academy of Hospice and Palliative Medicine Terms and Conditions

Fig. 2 Degree of breathlessness in relation to levels of functional status, distress, and palliative care (PC) needs over time. In graphs a, c, and e, breathlessness severity is plotted as a function of the degree of functional status, distress, or PC needs (total POS score) over time by disease group. In graphs b, d, and f, the degree of functional status, distress, or PC needs (total POS score) is plotted as a function of patients' breathlessness severity. POS=Palliative care Outcome Scale; KPS=Karnofsky Performance Status Scale; COPD=chronic obstructive pulmonary disease; LC=lung cancer; NCCN DT=National Comprehensive Cancer Network Distress Thermometer. Journal of Pain and Symptom Management 2014 48, 569-581.e1DOI: (10.1016/j.jpainsymman.2013.11.011) Copyright © 2014 American Academy of Hospice and Palliative Medicine Terms and Conditions

Fig. 4 Backward analysis: breathlessness severity, functional status, distress, and PC needs in the last 12 months of life of COPD and LC decedents. The graph shows the means of breathlessness severity (modified Borg scale) (a), distress (NCCN DT) (b), functional status (KPS transformed) (c) and PC needs (POS sum score transformed) (d), by disease group backwards over time in months from death. In the table, for both disease groups the numbers of patients, the means (bold) and SDs for each outcome are presented per month from death. COPD=chronic obstructive pulmonary disease; LC=lung cancer; CI=confidence interval; KPS=Karnofsky Performance Status Scale; NCCN DT=National Comprehensive Cancer Network Distress Thermometer; PC=Palliative Care, POS=Palliative care Outcome Scale. Journal of Pain and Symptom Management 2014 48, 569-581.e1DOI: (10.1016/j.jpainsymman.2013.11.011) Copyright © 2014 American Academy of Hospice and Palliative Medicine Terms and Conditions

Fig. 3 Kaplan-Meier estimates of survival according to disease group. Survival was calculated from the date of enrollment to the date of death or last follow-up (cutpoint on September 5, 2012). Median estimate of survival for LC patients was 312 days (95% CI=118–506); median could not be calculated for the COPD group because less than half of the population died during the time of observation (P<0.001, log-rank test). Tick marks indicate censoring of data. COPD=chronic obstructive pulmonary disease; LC=lung cancer. Journal of Pain and Symptom Management 2014 48, 569-581.e1DOI: (10.1016/j.jpainsymman.2013.11.011) Copyright © 2014 American Academy of Hospice and Palliative Medicine Terms and Conditions