Palliative care: needs of advanced breast cancer patients

Figures & data

Table 1 Potentially treatable causes of breathlessness

Underlying cause	Potential treatment
Anemia	Blood transfusion
Acidosis	HCO3
Bronchospasm	Bronchodilator therapy
Pneumonia	Antibiotic therapy
Pulmonary embolus	Anti-coagulate
Pneumonitis	Steroids
Atrial fibrillation	Anti-arrhythmic
Congestive cardiac failure	Diuretic
Pericardial tamponade	Drainage
Pleural effusion	Thoracentesis
Endobronchial tumor	Endobronchial laser
Extrinsic compression of bronchus	Radiotherapy
Carcinomatous lymphangitis	Steroids (anecdotes only)
Lung metastases	Chemotherapy/hormonal therapy

Table 2 Common expressions and themes of anxiety and their clinical manifestations

Expression of anxiety	Common clinical presentations
Fearfulness	Often characterized by apprehension and dread When severe, may become even more exaggerated and manifest as panic or alarm
Physical reactions not attributable to organic disease or drug reactions	Hyperventilation Sensation of lump in throat Palpitations Tightness in chest or stomach Nausea
Thought confusion	Difficulty in concentrating Difficulty in assimilating or recalling information Altered perceptions such as seeing the environment, procedures or treatments as threatening
Restlessness	Hyper vigilance about new treatments or symptoms Phobic avoidance of feared procedures or situations Paralysis of effective coping Indecision and poor sleeping Poor sleeping
Themes of anxiety	Common clinical presentations
Uncertainty	Anxiety about outcome of treatments Anxiety about likelihood of cure or relapse Anxiety about duration of survival Anxiety about unfamiliar treatments and procedures
Life under siege	Fear that their lives have been surrounded and overtaken by forces that threaten both the present and possibly the future too
Fear of progression	Fears with respect to the progression of their illness and its possible sequellae^Citation38

Table 3 Common symptoms of depression

Symptoms of depression	Common clinical presentations
Mood alteration	Persistent sadness Flatness of affect Emotionally withdrawn and unresponsive
Ruminative negative thoughts	Preoccupation with intrusive thoughts about the illness and its implications Distracted and unable to focus on other tasks at home or at work
Passivity	Disengagement from usual activities and interests Low motivation to do anything Lack of interest in the other issues going on in their lives
Poor sleep and appetite	Poor sleep and appetite unrelated to the illness or its treatment.

Table

Energy expenditure planning	Planning of daily activities or prioritizing activities to be undertaken at times of leased fatigue and maximal energy
Energy restoration strategies	Ensuring adequate rest and nutrition, reducing stress through techniques such as meditation or relaxation
Physical exercise	Endorsed as a useful approach in many clinical trials^Citation34 The level of physical exercise needs to be tailored to the underlying performance status and general well-being of the patients

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