Multicentre randomised controlled trial of nursing intervention for breathlessness in patients with lung cancer

BMJ 1999;318:901 (full) ( 3 April )

Papers

Four papers appear in the print BMJ this week in abridged form. The full and abridged versions are both available here on our website. The editorial by Delamothe et al explains why we are doing this, and we welcome readers' reactions. The paper by Whitehead (p. 908) appears in two abridged versions, one much shorter than the other; again we welcome readers' reactions on which they prefer, and why.

Multicentre randomised controlled trial of nursing intervention for breathlessness in patients with lung cancer

Editorial by Delamothe et al

Mary Bredin, Macmillan research practitioner, ^a Jessica Corner, professor of cancer nursing, ^b Meinir Krishnasamy, Macmillan research coordinator, ^a Hilary Plant, research practitioner, ^b Chris Bailey, research practitioner, ^b Roger A'Hern, statistician. ^c

^a Centre for Cancer and Palliative Care Studies, Macmillan Practice Development Unit, Institute of Cancer Research, Royal Marsden NHS Trust, London SW3 6JJ, ^b Centre for Cancer and Palliative Care Studies, Institute of Cancer Research, ^c Department of Computing and Information, Royal Marsden NHS Trust

Correspondence to: Jessica Corner jessica{at}icr.ac.uk

Objective: To evaluate the effectiveness of nursing interventionfor breathlessness in patients with lungcancer.
Design: Patients diagnosed with lung cancer participatedin a multicentre randomised controlled trial where they eitherattended a nursing clinic offering intervention for their breathlessnessor received best supportive care. The intervention consisted ofa range of strategies combining breathing control, activity pacing,relaxation techniques, and psychosocial support. Best supportivecare involved receiving standard management and treatment availablefor breathlessness, and breathing assessments. Participants completeda range of self assessment questionnaires at baseline, 4 weeks,and 8weeks.
Setting: Nursing clinics within 6 hospital settingsin the UnitedKingdom.
Participants: 119 patients diagnosed with small cell ornon-small cell lung cancer or with mesothelioma who had completedfirst line treatment for their disease and reportedbreathlessness.
Outcome measures: Visual analogue scales measuring distressdue to breathlessness, breathlessness at best and worst, WHO performancestatus scale, hospital anxiety and depression scale, and Rotterdamsymptomchecklist.
Results: The intervention group improved significantlyat 8 weeks in 5 of the 11 items assessed: breathlessness at best,WHO performance status, levels of depression, and two Rotterdamsymptom checklist measures (physical symptom distress and breathlessness)and showed slight improvement in 3 of the remaining 6items.
Conclusion: Most patients who completed the study hada poor prognosis, and breathlessness was typically a symptom oftheir deteriorating condition. Patients who attended nursing clinicsand received the breathlessness intervention experienced improvementsin breathlessness, performance status, and physical and emotionalstates relative to controlpatients.

Key messages

In lung cancer, high levels of distress, anxiety, and functional impairment are associated with the symptom of breathlessness
Evidence on the use of many treatments for this common and frightening symptom is lacking
Interventions based on psychosocial support, breathing control, and learning coping strategies can help patients to cope with the symptom of breathlessness and reduce physical and emotional distress

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