Breathlessness, functional status, distress, and palliative care needs over time in patients with advanced chronic obstructive pulmonary disease or lung cancer: a cohort study

J Pain Symptom Manage. 2014 Oct;48(4):569-81.e1. doi: 10.1016/j.jpainsymman.2013.11.011. Epub 2014 Mar 12.


Context: Breathlessness is a distressing symptom in advanced disease. Understanding its patterns, burden, and palliative care (PC) needs over time is important to improve patients' quality of life.

Objectives: To describe and compare the courses of refractory breathlessness, functional status, distress, and PC needs in patients with advanced chronic obstructive pulmonary disease (COPD) or lung cancer (LC) over time.

Methods: This was a cohort study of patients with COPD (Stage III/IV) or LC. Data were assessed monthly with up to 12 telephone interviews, using the modified Borg Scale, Karnofsky Performance Status Scale, Distress Thermometer, and Palliative care Outcome Scale as outcomes measures. Descriptive analysis compared all outcomes between COPD and LC at baseline and over time (forward from study entry and backward from death).

Results: A total of 82 patients (50 COPD and 32 LC), mean (SD) age of 67.2 (7.8), and 36% female were included (8 COPD and 23 LC deceased). The patients with COPD perceived higher levels of breathlessness and distress at lower functional status steadily over time. The LC patients' breathlessness, distress, and PC needs increased, whereas functional status decreased toward death. The PC needs were similar between disease groups. Breathlessness was negatively correlated with functional status (COPD=mean r=-0.20, P=0.012; LC=mean r=-0.277, P=0.029) and positively correlated with PC needs in COPD patients (mean r=0.343, P<0.001). Death was significantly predicted by diagnosis (LC: hazard ratio=7.84, P<0.001) and functional status (10% decline: hazard ratio=1.52, P=0.001).

Conclusion: The PC needs of patients with advanced COPD are comparable with LC patients, and breathlessness severity and distress are even higher. The care for COPD patients requires further improvement to address symptom burden and PC needs.

Keywords: Dyspnea; chronic obstructive pulmonary disease; cohort study; distress; functional status; lung cancer; needs assessment; palliative care.

Publication types

  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cohort Studies
  • Comorbidity
  • Dyspnea / diagnosis
  • Dyspnea / epidemiology*
  • Dyspnea / therapy
  • Female
  • Germany / epidemiology
  • Humans
  • Longitudinal Studies
  • Lung Neoplasms / diagnosis
  • Lung Neoplasms / mortality*
  • Lung Neoplasms / therapy*
  • Male
  • Middle Aged
  • Needs Assessment*
  • Palliative Care / statistics & numerical data*
  • Prevalence
  • Pulmonary Disease, Chronic Obstructive
  • Stress, Psychological / diagnosis
  • Stress, Psychological / epidemiology*
  • Stress, Psychological / therapy
  • Survival Rate