Breathlessness discussions in oncology consultations: An exploratory quantitative analysis.

CONTEXT: Chronic breathlessness is a prevalent, distressing and debilitating symptom in people with life-limiting conditions, including cancer. Despite this, patients report that breathlessness is often ignored in routine clinical consultations. OBJECTIVES: To explore whether breathlessness is discussed in oncology consultations and, if so, how it is assessed and managed. METHODS: An exploratory sub-analysis of a mixed-methods study combining audio-recorded oncology consultations and post-consultation interviews with patients self-identifying breathlessness as concern (or not). Adults (≥18 years; any cancer/stage; able to provide informed consent and converse in English or with the help of an interpreter) in two hospitals' oncology outpatient clinics. Routine consultations (audio-recorded; transcribed; coded) and participant data (demographics; cancer type/stage; breathlessness; functional status; quality of life) are described. RESULTS: In 54 consultations with individual patients, seven (13%) patients (median age 74 [IQR 63-78]; male 71%; advanced cancer 100%) were concerned by breathlessness, a topic raised in 22/54 (41%) of consultations. In patients concerned about breathlessness, the symptom was raised in 5/7 (71%) consultations, mostly by patients (3/5;60%); however, it was not raised in the two patients with the most severe breathlessness (2/7;29%). In patients not concerned about breathlessness, the symptom was raised in 17/47 (36%) consultations, primarily by clinicians (14/17;82%). Breathlessness discussions focused on symptom history (5/5; 8/17), leading to no further action (3/5) nor specific outcomes (12/17). CONCLUSION: Chronic breathlessness was raised in less than half of the people with advanced cancers and not identified for those with the most severe breathlessness. Discussions offered no breathlessness-control advice.