Journal of Digestive Cancer Research

  • 제11권2호
  • /
  • Pages.108-113
  • /
  • 2023
  • /
  • 2950-9394(pISSN)
  • /
  • 2950-9505(eISSN)
대한소화기암연구학회 (Korean Society of Gastrointestinal Cancer Research)
권호 표지
DOI QR코드

DOI QR Code

소화기 암환자 호흡곤란의 정확한 평가와 치료

Accurate Evaluation and Treatment of Dyspnea in Patients with Gastrointestinal Cancer

  • 이종윤 (동아대학교병원 내과학교실 소화기내과)
  • Jong Yoon Lee (Division of Gastroenterology, Department of Internal Medicine, Dong-A University Hospital)
  • 투고 : 2023.02.23
  • 심사 : 2023.03.08
  • 발행 : 2023.08.20
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Dyspnea is a common symptom among patients with gastrointestinal cancer, and a comprehensive evaluation of their respiratory function is essential. Self-reporting aids in the assessment of the degree of dyspnea, while objective examination methods are performed to identify the potential underlying causes when subjective symptoms are present. Standard treatment protocols should be followed for potentially reversible and common causes of dyspnea, such as pleural effusion, pneumonia, airway obstruction, anemia, asthma, exacerbation of chronic obstructive pulmonary disease, pulmonary thromboembolism, or drug-induced interstitial lung disease. Careful and close monitoring is required due to the high frequency of pulmonary thromboembolism and the risk of cardiovascular accidents, drug-induced interstitial lung disease, or other complications from some anticancer drugs. In case of hypoxemia with an oxygen saturation of 90% or less, palliative treatment should comprise standard oxygen therapy such as nasal cannula, mask, or high-flow nasal cannula. If non-pharmacological oxygen therapy is not effective, pain control through systemic narcotic analgesics and anti-anxiety therapy with benzodiazepines may be helpful.

키워드

참고문헌

  1. Ferlay J, Colombet M, Soerjomataram I, et al. Cancer statistics for the year 2020: an overview. Int J Cancer 2021;149:778-789. https://doi.org/10.1002/ijc.33588
  2. Parshall MB, Schwartzstein RM, Adams L, et al. An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med 2012;185:435-452. https://doi.org/10.1164/rccm.201111-2042ST
  3. Solano JP, Gomes B, Higginson IJ. A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease. J Pain Symptom Manage 2006;31:58-69. https://doi.org/10.1016/j.jpainsymman.2005.06.007
  4. Seow H, Barbera L, Sutradhar R, et al. Trajectory of performance status and symptom scores for patients with cancer during the last six months of life. J Clin Oncol 2011;29:1151-1158. https://doi.org/10.1200/JCO.2010.30.7173
  5. Hui D, Bruera E. The Edmonton Symptom Assessment System 25 years later: past, present, and future developments. J Pain Symptom Manage 2017;53:630-643. https://doi.org/10.1016/j.jpainsymman.2016.10.370
  6. Campbell ML, Kero KK, Templin TN. Mild, moderate, and severe intensity cut-points for the Respiratory Distress Observation Scale. Heart Lung 2017;46:14-17. https://doi.org/10.1016/j.hrtlng.2016.06.008
  7. Hui D, Bohlke K, Bao T, et al. Management of dyspnea in advanced cancer: ASCO guideline. J Clin Oncol 2021;39:1389-1411. https://doi.org/10.1200/JCO.20.03465
  8. Blom JW, Vanderschoot JP, Oostindier MJ, Osanto S, van der Meer FJ, Rosendaal FR. Incidence of venous thrombosis in a large cohort of 66,329 cancer patients: results of a record linkage study. J Thromb Haemost 2006;4:529-535. https://doi.org/10.1111/j.1538-7836.2006.01804.x
  9. Tonnesen J, Pallisgaard J, Rasmussen PV, et al. Risk and timing of venous thromboembolism in patients with gastrointestinal cancer: a nationwide Danish cohort study. BMJ Open 2023;13:e062768. https://doi.org/10.1136/bmjopen-2022-062768
  10. Carrier M, Abou-Nassar K, Mallick R, et al. Apixaban to prevent venous thromboembolism in patients with cancer. N Engl J Med 2019;380:711-719. https://doi.org/10.1056/NEJMoa1814468
  11. Ay C, Beyer-Westendorf J, Pabinger I. Treatment of cancer-associated venous thromboembolism in the age of direct oral anticoagulants. Ann Oncol 2019;30:897-907. https://doi.org/10.1093/annonc/mdz111
  12. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 2016;149:315-352. https://doi.org/10.1016/j.chest.2015.11.026 Erratum in: Chest 2016;150:988. https://doi.org/10.1016/j.chest.2016.08.1442
  13. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J 2020;41:543-603. https://doi.org/10.1093/eurheartj/ehz405
  14. Takeda T, Sasaki T, Fukuda K, et al. Risk factors for gemcitabine plus nab-paclitaxel-induced interstitial lung disease in pancreatic cancer patients. Int J Clin Oncol 2021;26:543-551. https://doi.org/10.1007/s10147-020-01827-2
  15. Irie H, Suzuki R, Takagi T, et al. Interstitial lung disease in advanced pancreatic ductal adenocarcinoma patients treated with gemcitabine and nab-paclitaxel combination therapy: a retrospective analysis. Cancer Chemother Pharmacol 2020;85:517-523. https://doi.org/10.1007/s00280-019-03983-3
  16. Suthar KH, Al Mutar S, Venkatesan R. Oxaliplatininduced pulmonary toxicity: a rare but serious complication. Cureus 2020;12:e7483. https://doi.org/10.7759/cureus.7483
  17. Yague XH, Soy E, Merino BQ, Puig J, Fabregat MB, Colomer R. Interstitial pneumonitis after oxaliplatin treatment in colorectal cancer. Clin Transl Oncol 2005;7:515-517. https://doi.org/10.1007/BF02717006
  18. De Weerdt A, Dendooven A, Snoeckx A, Pen J, Lammens M, Jorens PG. Prognosis and treatment of FOLFOX therapy related interstitial pneumonia: a plea for multimodal immune modulating therapy in the respiratory insufficient patient. BMC Cancer 2017;17:586. https://doi.org/10.1186/s12885-017-3576-y
  19. Pietra GG. Pathologic mechanisms of drug-induced lung disorders. J Thorac Imaging 1991;6:1-7. https://doi.org/10.1097/00005382-199101000-00003
  20. Shimura T, Fuse N, Yoshino T, et al. Clinical features of interstitial lung disease induced by standard chemotherapy (FOLFOX or FOLFIRI) for colorectal cancer. Ann Oncol 2010;21:2005-2010. https://doi.org/10.1093/annonc/mdq061 Erratum in: Ann Oncol 2010;21:2297.
  21. Polk A, Vistisen K, Vaage-Nilsen M, Nielsen DL. A systematic review of the pathophysiology of 5-fluorouracilinduced cardiotoxicity. BMC Pharmacol Toxicol 2014;15:47. https://doi.org/10.1186/2050-6511-15-47
  22. Van Leeuwen MT, Luu S, Gurney H, et al. Cardiovascular toxicity of targeted therapies for cancer: an overview of systematic reviews. JNCI Cancer Spectr 2020;4:pkaa076. https://doi.org/10.1093/jncics/pkaa076
  23. Bronte G, Bronte E, Novo G, et al. Conquests and perspectives of cardio-oncology in the field of tumor angiogenesis-targeting tyrosine kinase inhibitor-based therapy. Expert Opin Drug Saf 2015;14:253-267. https://doi.org/10.1517/14740338.2015.986092
  24. Weyhe D, Obonyo D, Uslar V, Tabriz N. Effects of intensive physiotherapy on Quality of Life (QoL) after pancreatic cancer resection: a randomized controlled trial. BMC Cancer 2022;22:520. https://doi.org/10.1186/s12885-022-09586-1
  25. Kim JY, Lee MK, Lee DH, et al. Effects of a 12-week home-based exercise program on quality of life, psychological health, and the level of physical activity in colorectal cancer survivors: a randomized controlled trial. Support Care Cancer 2019;27:2933-2940. https://doi.org/10.1007/s00520-018-4588-0
  26. Hui D, Morgado M, Chisholm G, et al. High-flow oxygen and bilevel positive airway pressure for persistent dyspnea in patients with advanced cancer: a phase II randomized trial. J Pain Symptom Manage 2013;46:463-473. https://doi.org/10.1016/j.jpainsymman.2012.10.284
  27. Nava S, Ferrer M, Esquinas A, et al. Palliative use of non-invasive ventilation in end-of-life patients with solid tumours: a randomised feasibility trial. Lancet Oncol 2013;14:219-227. https://doi.org/10.1016/S1470-2045(13)70009-3
  28. Pinna MA, Bruera E, Moralo MJ, Correas MA, Vargas RM. A randomized crossover clinical trial to evaluate the efficacy of oral transmucosal fentanyl citrate in the treatment of dyspnea on exertion in patients with advanced cancer. Am J Hosp Palliat Care 2015;32:298-304. https://doi.org/10.1177/1049909113513063
  29. Hardy J, Randall C, Pinkerton E, Flatley C, Gibbons K, Allan S. A randomised, double-blind controlled trial of intranasal midazolam for the palliation of dyspnoea in patients with life-limiting disease. Support Care Cancer 2016;24:3069-3076. https://doi.org/10.1007/s00520-016-3125-2
  30. Dipper A, Jones HE, Bhatnagar R, Preston NJ, Maskell N, Clive AO. Interventions for the management of malignant pleural effusions: a network meta-analysis. Cochrane Database Syst Rev 2020;4:CD010529. https://doi.org/10.1002/14651858.CD010529.pub3