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Research Helpful for Breathlessness

Managing Breathlessness:  A Symptom of Mesothelioma

Malignant mesothelioma is an aggressive cancer which causes the growth of tumors in the abdominal cavity, the chest cavity, and around vital organs such as the heart and lungs.  Not only do these tumors place undue pressure on these organs, the resulting increased fluid magnifies the effect.  In fact, the first noticeable sign of mesothelioma for many patients is shortness of breath caused by this internal pressure.  That’s because the tumors and excess fluid are pressing on the lungs (decreasing the amount of air they can inhale) or on portions of the cardiovascular system making the transfer of oxygenated blood to the muscle more difficult. 

Because breathlessness is one of the first symptoms of mesothelioma that victims notice, it can often confuse the diagnostic process and lead to missed diagnoses or delays in identifying the illness.  Why?  Because breathlessness is a key symptom for many other types of illnesses including a variety of cardiovascular problems and respiratory illnesses such as asthma and COPD.

As the mesothelioma progresses, the breathlessness may increase to the point where patients may suffer greatly decreased mobility.  That decreased mobility has a detrimental effect on the body’s overall conditioning, which may, in turn, decrease the effectiveness of mesothelioma treatments and hasten the progression of the illness or increase the severity of other symptoms.  Researchers call this cyclic chain of events a “downward spiral” and until recently little was known about the actual symptom (duration, severity, etc.) of breathlessness.

Study Designed to Help Patients and Doctors Understand Breathlessness

Several researchers in the United Kingdom recently undertook the task of really learning the extent of this mesothelioma symptom.  Their goal was to better define a method of treatment or rehabilitation for that breathlessness that could aid patients in coping with mesothelioma.

Matthew Maddocks, of the Cicely Saunders Institute in the Department of Palliative at Care Kings College in London, worked closely with a team from the Department of Palliative Medicine, part of the University Hospitals NHS Trust,  in Nottingham to devise a test that would get to the heart of breathlessness.

First, the research team collected a sample group of 57 patients suffering from some form of thoracic cancer, including 11 with mesothelioma.  Thirty of those patients were male with an average age of 63.  

They then had the patients undergo the Shuttle Test Walk.  The test is a standard method of simulating physical exertion.  Essentially, cones were set up around which the patients walked.  An audio recording was used to set the tempo with the speed increasing every few minutes.  Patients were instructed to walk for as long as they could and then stop when they either experienced too much pain to continue or felt so far short of breath that they couldn’t keep up.

Once the patients stopped walking, they were immediately assessed with a modified Borg scale, a device to measure for perceived discomfort.  They were asked to rate their level of discomfort on a numerical scale with lower numbers corresponding with low levels of discomfort and high numbers to higher levels.

This modified Borg test was administered again every minute until the patient’s perceived level of discomfort fell back to the baseline—how they were feeling before they began the walking exercise.

The results were not surprising.  Patients walked an average distance of just 360 meters and for an average duration of 373 seconds.

Patients then rated themselves on the modified Borg scale, on average, around 3, between 2 as “slight” and 4 as “somewhat severe”.  However, several respondents fell on the outside of this median range and rated themselves at either 0.5 “very, very slight” to 8 “very, very severe.”

As far as duration of discomfort was concerned, the patients reported between one and seven minutes with most falling right around the four minute mark.

Conclusion from the Test

The data showed that breathlessness, though sometimes reported as severe in mesothelioma patients and other cancer victims, occurred rather quickly but also dissipated rather quickly. 

This realization presents a unique challenge for doctors and patients—the timespan during which patients “regained their breath” was much too short to allow for effective administration of any sort of medication.  That means that patients must simply endure the breathlessness until it passes.

However, the researchers did notice, not unexpectedly, that those patients who were either younger or more physically able at the beginning of the test were able to walk for longer periods of time and regained their breath quicker than others.  This led them to conclude that the best method of combatting breathlessness is a preventative measure including physical rehabilitation practices.