How standard is 'standard care' in the symptom management of patients with lung cancer? The example of the 'respiratory distress' symptom cluster.

摘要

Ten years ago the NHS Cancer Plan (DH, 2000) acknowledged that although surveys had shown that cancer patients give high priority to receiving the best possible symptom control, too many patients 'still experience distressing symptoms' (DH, 2000: 66). The situation appears to be little changed, and symptom control remains one of the most prevalent areas of unmet needs amongst cancer patients (Rainbird et al., 2009). Symptom distress has been shown to be a strong predictor of survival, and pharmacological interventions alone often do not adequately relieve symptoms and indeed may also cause adverse effects (Bausewein et al., 2008). Moreover, patients with cancer rarely present with a single symptom. Rather, patients often experience several concurrent symptoms, and recognition of this has led to an increasing research focus upon the existence of 'symptom clusters' around specific diseases. Understanding such clusters promises to improve management, and a respiratory distress 'symptom cluster' among lung cancer patients has recently been identified, with close associations between breathlessness, cough and fatigue (Molassiotis et al, 2011).