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Episodic breathlessness in patients with cancer: definition, terminology, clinical features – integrative systematic review
  1. Joaquim Julià-Torras1,2,
  2. Deborah Moreno-Alonso2,3,
  3. Josep Porta-Sales2,3 and
  4. Cristina Monforte-Royo4
  1. 1 Palliative Care Department, Institut Català d'Oncologia, Badalona, Spain
  2. 2 School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
  3. 3 Palliative Care Department, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain
  4. 4 Department of Nursing, Universitat Internacional de Catalunya—Campus Sant Cugat, Sant Cugat del Valles, Spain
  1. Correspondence to Dr Joaquim Julià-Torras, Palliative Care Department, Institut Català d'Oncologia, Badalona, 08916, Spain; jjulia{at}


Purpose Breatlessness flares directly impair quality of life of patients with cancer. The aim of this review was to analyse and synthesise the available information related to its terminology, definition and clinical features in patients with cancer.

Methods Integrative systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Literature search was conducted in MEDLINE PubMed, CINAHLPlus, Web of Science, Cochrane Central Register Controlled Trials CENTRAL, Scopus and OpenAire.

Results Data from 1065 patients with cancer included in 12 studies were analysed. The preferred term for breathlessness flares was episodic dyspnoea (ED). The reported frequency of ED was 20.4% (70.9% in patients reporting background dyspnoea (BD)). ED intensity was moderate to severe with short duration (<10 min) in >80% of patients. The most common trigger was exertion (>90%) followed by emotional or environmental factors. ED management consisted mainly of pharmacological and non-pharmacological measures.

Conclusions This systematic review shows that ED is common in patients with cancer, especially in those with BD. Further studies are urgently needed to better understand this condition and to develop specific therapeutic management.

PROSPERO registration number CRD42019126708.

  • Dyspnoea
  • Supportive care
  • Respiratory conditions
  • Clinical assessment
  • Lung

Data availability statement

No data are available.

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  • Contributors DM-A performed the search. JJ-T and DM-A separately screened and independently assessed the articles identified in the search after duplicates were removed. Disagreements regarding the inclusion or not of a given article were resolved by JP-S. JJ-T extracted the information from the articles and wrote the initial version of the manuscript, that was thoroughly reviewed by JP-S, DM-A and CM-R. All the authors contributed to the final version and read and approved the final manuscript. JJ-T was the responsible for the overall content as the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.