Dyspnea in pediatric oncology patients with advanced cancer and at end of life has been well documented in the literature. In a landmark study by Wolfe and colleagues. (2000), 65% of parents of pediatric oncology patients reported distressing dyspnea at end of life with less than 30% of those patients receiving adequate treatment.
Frequently, children are undertreated, and occasionally they are over-treated, for their dyspnea because of an uncertainty of treatment methods and normal breathing patterns in a dying patient. Dyspnea that is not well managed in those with advanced cancer may result in a decreased quality of life, preventing the child/adolescent from being able to partake in the activities they enjoy. Undertreating dyspnea at end of life may result in tremendous distress for patients and their families as they struggle to breathe. Over-treatment may lead to hastening a patient’s death.
Several treatment modalities have been utilized to manage dyspnea in advanced cancer, including radiation therapy, oxygen, blood transfusions, placement of tubes/drains, and medications/opioids. Nonpharmacological management, such as positioning, meditation, guided imagery or hypnosis, can also be effective at treating dyspnea. Opioids are the gold standard of treatment at end of life, but what is the best route and frequency for administration? Is intravenous access required to effectively deliver these medications? The clinician may be unaware of normal and abnormal breathing patterns a patient experiences at end of life, resulting in mismanagement of dyspnea during a patient’s final hours. Understanding the evidence and pharmacology behind these treatment modalities and having the ability to assess distressing breathing patterns at the end of life can position the pediatric oncology nurse to better advocate for and manage dyspnea in children with advanced cancer and at end of life.
The current evidence and use of medications, radiation therapy, oxygen, blood transfusions, placement of pleural drains, and nonpharmacological management of dyspnea will be explored. Videos of children experiencing their final minutes or hours of life will be used as examples for how and when to use medications appropriately. By expanding the nurse’s knowledge, or the horizon, of the management of dyspnea, care of the pediatric oncology patient with advanced cancer will be improved.
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