1. Terence Seemungal The University of the West Indies The Prevalence of Dyspnoea in Palliative Care Head, Adult Medicine Unit, UWI 1 Professor of Medicine Department of Clinical Medical Sciences Programme Director Postgraduate Medicine

2. Palliative Care: The need in T&T Three hospitals: EWMSC, POSGH, SFGH several doctors did not fully understand the meaning of the word “palliative” as the majority thought this exclusively applied to cancer patients only Example: “You mean that you’re looking for cancer patients?” It appeared that the nurses were better able to identify these patients and showed a better understanding when asked further about the patient’s condition Unable to quantify these observations at present Mudden A, Samodee S, Seemungal T. (Unpublished)

3. By Hospital or Department N = 760 pats., 53(6.9%) reqd Pall care

4. What is dyspnoea? Dyspnoea may be defined as the uncomfortable awareness of breathing The feeling / sensation that you cannot get enough air into your lungs Shortness of breath It is subjective It is a symptom

5. What dyspnoea is not Rapid breathing (tachynoea) Deep breathing (hyperpnoea) Though all of the above may be associated with dypnoea

6. Frequency of Dyspnoea in End Stage Diseases Edmunds et al. Pall Med 2001; Gibbs Et al. BMJ 1998; Foley et al. Neuol Clin 2001; Kristjanson et al. Med J Austr 2003 (S); VolpeBT. Neurol Clin 2001;

7. Dyspnoea Trajectories Dyspnea is the most distressing symptom experienced by critically ill patients at risk for dying New data suggests different stages of onset of dyspnoea prior to death Patients with noncancer diagnoses, particularly chronic obstructive pulmonary disease, experience severe dyspnoea for months before death whereas patients with cancer even without apparent cardiorespiratory disease have an escalation of dyspnoea near death The sickest patients and those who are cognitively impaired or unconscious are not represented because self-report measures are used Campbell M. Curr Opin Support Palliat Care. 2012

8. Cancer patients on Chemotherapy: Symptoms Clusters One Japanese Study of 462 patients during follow-up found 4 major clusters of symptoms: 1) psychosocial issues (insomnia, psychological distress, decision-making support); 2) nutrition-gastrointestinal issues (oral problems, appetite loss, nausea); 3) fatigue; and 4) pain, dyspnea, and numbness. Yamagish et al. J Pain and Symptom Manage 2009.

9. Advanced Cancer and Dyspnoea 135 patients with end stage lung cancer Pain Clinic ( M.D. Anderson Cancer Centre, Texas ) Moderate to severe dyspnoea in 55% Severity of dyspnoea related to lung involvement ( P = 0.0016 ) and anxiety ( P = 0.0027 ) Bruera et al. J Pain Symptom Manage. 2000

10. The Take Home Message Dyspnoea is a disabling and subjective sensation of inability to breathe Dyspnoea is common in all end stage diseases Dyspnoea may cluster with other symptoms such as pain and numbness In cancer patients lung involvement and anxiety are related to dyspnoea

11. Thank you