Connors, S., Graham, S., & Peel, T. (2007). An evaluation of a physiotherapy led non-pharmacological breathlessness programme for patients with intrathoracic malignancy. Palliative Medicine, 21(4), 285–287.

• Week 1: Breathing control and assessment
• Week 2: Review, relaxation, and anxiety management techniques
• Week 3: Review, energy conservation, goal setting, and lifestyle adaptation
• Week 4: Review and assessment
• Week 8: Review and re-assessment

This program was conducted for four years. The study was based on prior research conducted by Corner et al. (1996) and Bredin et al. (1999), also reported elsewhere in the table.

The study reported on a sample of 169 patients. All patients reported breathlessness as a symptom. Patients were referred from three sources to a physiotherapist-led breathlessness program for patients with intrathoracic malignancy. The three sources included an outpatient lung cancer clinic, the inpatient unit, or the community where they were referred by a specialist palliative care team. A screening questionnaire was used to identify the cause of breathlessness. If the cause was reversible, the patient received appropriate care. Only 14 of 169 completed the entire program.

The following tools were used at one, four, and eight weeks.

• Chronic Respiratory Disease Questionnaire
• Number counting
• VAS of breathlessness at worst and at best and distress related to breathlessness

Only 14 of 169 completed the entire program. The following are characteristics of the 14 who completed the program.

• Referred from the outpatient setting
• Had radical treatment
• Etiology of the breathlessness was either treatment-related or because of other causes but not from progression of disease.
• Median survival was 630 days

Of the 14 who completed the program, pre- and post-assessment scores showed modest improvement, but it was not statistically significant. The majority did not complete the program. One hundred thirty-one patients (85%) were seen at least once and anecdotally had subjective benefit. Of those who did not complete the program, some had progressive disease and were too ill to participate or died before being seen. Median survival was 95 days.

Patients with intra-thoracic cancer may benefit from a formal nonpharmacologic program. Patients who are frail and/or on palliative care may need a more flexible program.

One hundred fifty-five patients did not complete the program because of progressive disease and associated shorter survival. The small subset who did complete the program did not show significant improvement in dyspnea measures. Dropout rate was 82% versus 41% in the Corner study and 43% in the the Bredin study. Interventions in the three studies were similar. The difference in dropout rate for this study compared to Bredin and Corner’s studies is explained by the fact that the patients in this study were older and were recruited from the totality of patients with lung cancer presenting to the cancer center.