Shortness of Breath (Dyspnoea) in Childhood Cancer
Symptom Management, Palliative Care, or Supportive Care to relieve side-effects is an important part of cancer care and treatment and should always form part of the overall treatment plan.
Dyspnoea is a feeling of breathlessness that can be experienced by many people with advanced cancer or those with earlier-stage cancers who have other conditions that affect the heart or lungs. Distinct sensations include effort/work, chest tightness, and air hunger (the feeling of not enough oxygen).
Dyspnoea is a normal symptom of heavy exertion but becomes pathological if it occurs in unexpected situations. In 85% of cases it is due to Asthma, Pneumonia, Cardiac Ischemia, Interstitial Lung Disease, Congestive Heart Failure, Chronic Obstructive Pulmonary Disease, or psychogenic causes such as Panic Disorder and Anxiety.
An individual with a potentially life-threatening blood clot or other emergency, for example, may experience dyspnoea. It is important to inform your child’s doctor immediately should your child experience any symptoms of Dyspnoea.
It is thought that three main components contribute to dyspnoea: afferent signals, efferent signals, and central information processing. It is believed the central processing in the brain compares the Afferent and Efferent signals; and dyspnoea results when a “mismatch” occurs between the two: such as when the need for ventilation (afferent signalling) is not being met by physical breathing (efferent signalling).
Common symptoms of dyspnoea include:
- A feeling of smothering, tightness, drowning, or suffocation
- Shortness of breath
- The inability to get enough air
- Uncomfortable breathing
A person may experience dyspnoea even though the actual levels of oxygen are within a normal range. It is important to understand that people do not suffocate or die from dyspnoea.
Different physiological pathways may lead to shortness of breath including via ASIC chemoreceptors, mechanoreceptors, and lung receptors.
While shortness of breath is generally caused by disorders of the cardiac or respiratory system, other systems such as Neurological, Musculoskeletal, Endocrine, Hematologic, and Psychiatric may be the cause.
The most common cardiovascular causes are acute myocardial infarction and congestive heart failure while common pulmonary causes include chronic Obstructive Pulmonary Disease, Asthma, Pneumothorax, Pulmonary Oedema and Pneumonia.
Dyspnoea may also be caused by a tumour or by other conditions related to cancer, and many of these causes are treatable.
On a pathophysiological basis the causes can be divided into:
(1) An increased awareness of normal breathing such as during an anxiety attack,
(2) An increase in the work of breathing and
(3) An abnormality in the ventilatory system.
Some common causes of dyspnoea include the following:
- Fluid in the space between the edge of the lungs and the chest wall
- Inflammation of lungs after radiation treatment, called radiation pneumonitis
- Low red blood cell count
- Narrowing of the airway, called a bronchospasm
- Panic Attacks
- Shortage of oxygen in blood, called hypoxemia
- Something, such as a tumour, blocking the airway
To learn more about your symptoms, the doctor will review your medical history and ask you to describe your symptoms and any activities or other medical conditions that make the symptoms worse.
The initial approach to evaluation begins by assessment of the airway, breathing, and circulation followed by a medical history and physical examination.
A number of scales may be used to quantify the degree of shortness of breath such as The Modified Borg Scale in which breathlessness is rated on a scale from 1 to 10 with descriptors associated with the number.
Blood Tests may also be helpful in determining the cause of shortness of breath, and your child’s doctor may also order a chest x-ray to confirm or rule out a Pneumothorax, Pulmonary Oedema, or Pneumonia.
Relieving side effects is an important part of total cancer care and treatment, which is why you should discuss any symptoms your child is experiencing, new symptoms and changes in symptoms with their Oncology Team so that they can work out a regimen of palliative or supportive care for them.
An important step in managing dyspnoea is treating the cause, such as the tumour or a blood clot.
Your child’s doctor may also recommend the following to help to relieve the symptoms of dyspnoea:
- Giving your child anti-anxiety medication to manage the pain and anxiety of dyspnoea
- Giving your child extra oxygen; or, sitting them in front of a fan, which may be just as effective as extra oxygen
- Giving your child pain medications such as morphine, that act on the central nervous system
- Keeping your child’s head lifted; if they are in bed, use pillows to raise their head so that they are almost in a sitting position
- Letting your child breathe cleaner, cooler air by lowering the temperature in a room, opening a window, using a humidifier, or getting rid of any smoke and pet hair
- Providing a sense of open space by opening windows and allowing your child to seeing a view of the outside, or being in an empty room