Certain bio-psychosocial-spiritual problems associated with dyspnea among advanced cancer patients in Taiwan.

ABSTRACT

PURPOSE: Dyspnea is a multidimensional phenomenon among advanced cancer patients. We aim to explore the association between bio-psychosocial-spiritual problems and dyspnea among advanced cancer patients in Taiwan. METHODS: We retrospectively analyzed advanced cancer patients admitted to the hospice palliative ward in a tertiary hospital in Taiwan from 2002 to 2005. A total of 687 consecutive advanced cancer patients were enrolled. Physical, psychosocial, and spiritual problems for each patient were collected. Multiple logistic regression analyses were used to evaluate the association between dyspnea and other physical, psychosocial, and spiritual problems. RESULTS: The top four primary sites of cancer among these patients are the liver/biliary tract (19.9%), lung (15.6%), colon/rectum (12.8%), and head/neck (9.9%). During admission period, 260 (37.8%) patients experienced dyspnea. For primary cancer types and metastatic locations, subjects with dyspnea tended to have lung cancer, lung metastasis, or brain metastasis. The clinical symptoms/signs related to dyspnea are pain, anorexia, constipation, nausea/vomiting, coughing, pleural effusion, edema, anxiety, and propriety preparation problem, that is, arranging one's will, feelings of isolation, fear of death, and survival. After further adjustments for potential confounders, subjects with problems of propriety preparation were found to be strongly associated with dyspnea. The adjusted odds ratio of having dyspnea caused by the problem of propriety preparation was 1.91 (95% confidence interval, 1.15-3.19). CONCLUSIONS: Advanced cancer patients with certain psychosocial and spiritual problems, such as, the problem of propriety preparation, fear of death, and anxiety, tended to have dyspnea. Among these factors, propriety preparation plays an important role among dyspnea patients. Advanced cancer patients with dyspnea have greater needs for propriety preparation.