January 06, 2016
By Will Boggs MD
NEW YORK (Reuters Health) - Respiratory health-related quality of life (HRQoL) is worse in breathless COPD patients than in breathless cancer patients, researchers have found.
Although breathlessness is common in patients with advanced chronic obstructive pulmonary disease (COPD) and in patients with advanced cancers of all primary sites, little is known about the impact of breathlessness on HRQoL.
Dr. Morag Farquhar and colleagues from the University of Cambridge, U.K., used the Chronic Respiratory Questionnaire-Original (CRQ-Original) to examine differences in respiratory HRQoL between 139 patients with breathlessness due to advanced COPD or advanced cancer who were referred for palliative care.
Patients with advanced COPD had lower median scores for all four CRQ domains, compared with patients with advanced cancer, though the differences were statistically significant only for three domains: dyspnea, emotional function, and mastery.
The differences in emotional function and mastery exceeded the minimally clinically important difference of 0.5 (on a scale of 0-7), the researchers report in BMJ Supportive & Palliative Care, online December 18.
"Acknowledging that patients with advanced COPD experience breathlessness differently from those with cancer is imperative if we are to direct our interventions effectively and improve access to palliative care for patients with advanced COPD," the researchers conclude. "Further, formal psychometric testing of the CRQ in patients with respiratory symptoms due to cancer may be warranted to establish its suitability for use in this group, which could benefit both research and clinical practice."
Dr. Nicholas Wysham from Duke Clinical Research Institute in Durham, North Carolina, told Reuters Health by email that the cancer patients may have been referred for palliative care for a variety of reasons.
"Studies like these are complicated by the choice of comparisons. By choosing to compare groups at time of palliative care referral, (the authors) are able to make inferences about referral patterns more than they are about the patients or diseases themselves," said Dr. Wysham, who has done similar research. "A comparison with lung cancer patients (as was in my manuscript and others that preceded it), might be more appropriate and may or may not have demonstrated such a difference."
"Physicians who care for patients with advanced COPD should promptly recognize uncontrolled symptoms or persistent distress and manage these using the full range of therapeutic options, or make appropriate and timely referral to others who can," Dr. Wysham said. "This report suggests that brief HRQoL instruments, like the CRQ, CAT (COPD Assessment Test), and others, can be helpful for detecting patients with poor quality of life and should probably be incorporated into the routine care of such patients."
"To make capture of HRQoL more routine, though, we need to push EHR vendors and health systems to integrate these items within the medical record as discreet data, giving them the importance you might to a heart rate or a pain score," Dr. Wysham added. "Furthermore, rather than consume physicians' or nurses' time collecting and entering this data, we need to explore ways for these patients to directly contribute these survey items."
Dr. Farquhar was not available for comments.
BMJ Support Palliat Care 2015.
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