Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
Department of Psychosomatic Medicine, Kansai Medical University, Hirakata, Japan.
BMJ Support Palliat Care. 2024 Jan 8;13(e3):e1126-e1132. doi: 10.1136/bmjspcare-2021-003484.
Dyspnoea is a common and distressing symptom in patients with cancer. We aimed to analyse the association between dyspnoea and related factors and to estimate their causal relationship.
A cross-sectional study was conducted. Patients with cancer with dyspnoea and a mean Numerical Rating Scale (NRS) of ≥3 over 24 hours were enrolled at 10 institutions in Japan from December 2019 to February 2021. The outcomes included dyspnoea, cough and pain NRS over 24 hours, Eastern Cooperative Oncology Group Performance Status, Hospital Anxiety and Depression Scale, Somatosensory Amplification Scale, opioids for dyspnoea and respiratory failure. Path analyses were conducted to estimate the direct and indirect paths with reference to dyspnoea and related factors.
A total of 209 patients were enrolled and 208 patients were included in the analysis. Cough worsened dyspnoea (β=0.136), dyspnoea increased emotional distress (β=1.104), emotional distress increased somatosensory amplification (β=0.249) and somatosensory amplification worsened cough (β=0.053) according to path analysis.
There may be a vicious circle among dyspnoea and related factors: cough worsened dyspnoea, dyspnoea increased emotional distress, emotional distress increased somatosensory amplification and somatosensory amplification worsened cough. When treating dyspnoea in patients with cancer, managing these factors aimed at interrupting this vicious circle may be useful.
UMIN Clinical Trials Registry (UMIN000038820).
呼吸困难是癌症患者常见且令人痛苦的症状。本研究旨在分析呼吸困难与相关因素之间的关联，并评估它们之间的因果关系。
本研究为一项横断面研究。于 2019 年 12 月至 2021 年 2 月，在日本的 10 家机构中招募呼吸困难且 24 小时内平均数字评定量表（NRS）评分≥3 的癌症患者。主要结局指标包括 24 小时呼吸困难、咳嗽和疼痛 NRS 评分、东部肿瘤协作组体力状况评分、医院焦虑抑郁量表评分、躯体感觉放大量表评分、用于缓解呼吸困难和呼吸衰竭的阿片类药物。通过路径分析，参照呼吸困难和相关因素，评估直接和间接路径。
共纳入 209 例患者，其中 208 例患者纳入分析。路径分析结果显示，咳嗽加重呼吸困难（β=0.136），呼吸困难加重情绪困扰（β=1.104），情绪困扰加重躯体感觉放大（β=0.249），躯体感觉放大加重咳嗽（β=0.053）。
呼吸困难与相关因素之间可能存在恶性循环：咳嗽加重呼吸困难，呼吸困难加重情绪困扰，情绪困扰加重躯体感觉放大，躯体感觉放大加重咳嗽。在治疗癌症患者的呼吸困难时，管理这些因素以阻断恶性循环可能是有益的。
UMIN 临床研究注册（UMIN000038820）。
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