ONS Connect - August 2008 - (Page 18)

FIVEMINUTEINSERVICE AS Seen in tHe CliniCal Journal of onCology nursing Put Evidence Into Practice to Manage Dyspnea [By elisa Becze, BA, ONS Staff Writer] yspnea is a distressing symptom that occurs in approximately 15%–55% of patients with cancer at diagnosis and approximately 18%–79% of patients at the end of life. The condition can be caused directly by the cancer (e.g., primary or metastatic pulmonary parenchymal involvement, pleural tumor or effusion, superior vena cava syndrome), indirectly by cancer (e.g., cachexia, pneumonia, pulmonary aspiration), by the cancer treatment (e.g., surgery, radiation-induced pericardial disease, chemotherapy-induced cardiomyopathy), or by secondary conditions (e.g., asthma, congestive heart failure, anxiety, pneumothorax). Dyspnea is usually assessed using a visual analog scale. Cancer-related dyspnea may or may not reverse with treatment; irreversible cases must be treated with palliative therapies. Nursing interventions for the condition can be either pharmacologic or nonpharmacologic. In 2005, the ONS Putting Evidence Into Practice® (PEP®) Dyspnea Intervention Project Team reviewed, critiqued, and summarized the research evidence for nursing interventions for cancer-related dyspnea. Their work was reported in the April 2008 issue of Clinical Journal of Oncology Nursing (DiSalvo, Joyce, Tyson, Culkin, & Mackay, 2008). See Figure 1 for a summary of the PEP team’s recommendations and Figure 2 for a list of interventions supported by expert opinion. D Pharmacologic Interventions Although nonpharmacologic agents have been shown to benefit patients with cancer-related dyspnea, most patients require the additional use of pharmacologic agents. Opioids: Oral morphine is often used in the palliative setting. Other opioids are also used, including dihydrocodeine, codeine, and diamorphine. Only a small number of studies involving patients with cancer support the use of opioids in cancer-related dyspnea. However, the dysp- nea PEP team concluded that sufficient evidence from one meta-analysis and other studies exists for the use of immediate-release parenteral or oral morphine for dyspnea in the palliative setting and therefore is recommended for practice. Extended-release morphine or morphine plus midazolam’s effectiveness was not established by current evidence. Nebulized therapy: Inhalation of nebulized opioids is an appealing approach for dyspnea because it is thought that the local binding action to sensory receptors in The dyspnea PEP team concluded that sufficient evidence exists for the use of immediate-release parenteral or oral morphine for dyspnea in the palliative setting and therefore is recommended for practice. Key Definitions Dyspnea: characterizes a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity. The experience derives from interactions among multiple physiologic, psychological, social, and environmental factors and may induce secondary physiologic and behavioral responses. Nebulized therapy: aerosol medication inhaled as a fine mist that is deposited on the respiratory tract as a form of topical pulmonary treatment Visual analog scale (VAS): 100 mm line (either vertical or horizontal) with anchors at either end to indicate extremes of the sensation. Measuring the distance from the bottom of an original, noncopied scale (or left if it is horizontal) to the level indicated by the subject is the VAS score. Five-Minute In-Service is a monthly feature that offers readers a concise recap of a full-length article published in the Clinical Journal of Oncology Nursing (CJON) or Oncology Nursing Forum. This edition summarizes “Putting Evidence Into Practice: Evidence-Based Interventions for Cancer-Related Dyspnea” by Wendye M. DiSalvo, RN, MSN, ARNP, AOCN®, Margaret M. Joyce, MSN, RN, AOCN®, Leslie B. Tyson, MS, APN-BC, OCN®, Ann E. Culkin, RN, OCN®, and Kathleen Mackay, RN, BSN, OCN®, which was featured in the April 2008 issue of CJON. Questions regarding the information presented in this Five-Minute In-Service should be directed to the CJON editor at CJONEditor@ons.org. Photocopying of this article for educational purposes and group discussion is permitted. 18 ONS CONNECT August 2008

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ONS Connect - August 2008 Contents Editor's Note Just In Safe Handling of Chemotherapy A Year in the Life—Month Eight Put Evidence Into Practice to Manage Dyspnea Web Connect Capitol Connection Notice Nursing Now Caregiver Care KRAS Status Predicts Response to Cetuximab for Metastatic Colorectal Cancer Calendar of Events Working for You Staying on Top

ONS Connect - August 2008

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