Personalized goal for dyspnea and clinical response in advanced cancer patients.

AIM: The aim of this study was to assess the Personalized Dyspnea Intensity Goal, and the achievement of Personalized Goal Response and Patient Global impression, after comprehensive symptom management. The secondary outcome was to assess factors related to personalized goal response.

PATIENTS AND METHODS: Advanced cancer patients admitted to palliative care units rated pain and symptoms intensity, and their Personalized Dyspnea Intensity Goal , by using the Edmonton Symptom Assessment Score (ESAS). After a comprehensive symptom management, achievement of target patients' response and Patient Global Impression were evaluated.

RESULTS: 279 patients were analyzed in this study. The mean Personalized Dyspnea Intensity Goal at T0 and T7 were 0.97 (SD 1.3), and 0.71 (SD 2.1), respectively. 263 (94.2%) indicated a Personalized Dyspnea Intensity Goal of ≤3 as a target at T0. Patients perceived a bit better, a better improvement, and a much better improvement with a mean decrease in dyspnea intensity of - 2.1, -3.5, and -4.3 points on the dyspnea intensity scale, respectively. In 60 patients (21.5 %), dyspnea intensity did not change, and in 4.7%, dyspnea intensity worsened. Patients perceived a Minimal Clinically Important Difference (little worse) with a mean increase in dyspnea intensity of 0.10, and they perceived a worse with a mean increase of 1.7 points. Higher dyspnea intensity at T0 and lower dyspnea intensity at T7 were independently related to Patient Global Impression. At T7, 93 (33.3%) patients achieved their Personalized Goal Response, based on Personalized Dyspnea Intensity. Patient Dyspnea Goal Response was associated with Memorial Delirium Assessment Scale score and Personalized Dyspnea Intensity Goal at T0, and inversely associated with dyspnea intensity at T0 and T7, and lower Karnofsky level. For Patient Dyspnea Goal Response, no significant differences among categories of dyspnea intensity were found (P>0.05).

CONCLUSION: Patient Dyspnea Goal Response and Patient Global Impression seem to be relevant for evaluating the effects of a comprehensive management of symptoms, including dyspnea, assisting decision making process. Some factors may be implicated in determining the individual target and clinical response.