Charakteristika von Palliativpatienten mit Atemnot – Ergebnisse der Hospiz- und Palliativerhebungen (HOPE) von 2006 bis 2008

Background: Breathlessness is a common and distressing symptom in patients (pts) with advanced diseases. Aim: To describe demographical and clinical characteristics of pts suffering from breathlessness due to advanced disease. Methods: The Hospice and Palliative Care Evaluation (HOPE) is a prospective annual nationwide survey collecting patient outcome data for three months from palliative care patients (pts) in Germany. The presented data are a secondary analysis of palliative care pts from about 26 % of all specialised palliative care in-patient units (in-patient hospice (IPH) and palliative care unit (PCU)) in Germany between 2006 and 2008. Because of multiple testing the significance level is set at p<0.01. Results: 53.8% (2,860 pts) of 5,320 pts presented with breathlessness. The mean age of these pts were 67.2 years (SD 12.4), 51.4 % were female. 2,676 pts (93.6 %) had a malignant disease as primary diagnoses, predominantly cancer of the lung (female/ male - 15.7/ 29.5 %), breast (20.3/ 0.3 %) and colon (10.3/ 8.7 %). Compared with non-breathless patients (NBP) breathless pts (BP) had a significant lower functional status (ECOG 3 or 4: 78.4 % vs. 70.8 %, p<0.001) and had more often problems with activities of daily living (ADL, 92.9 % vs. 89.0 %, p<0.001). BP suffer from a larger amount of different symptoms (11.1 vs. 9.5, p<0.001) with higher intensity in all symptoms but one (confusion). Compared to NBP sedatives were used more often in BP (27.7 % vs. 24.8 %, p=0,015), while there was no difference in morphine prescription (62.9 % vs. 62.8 %, p=0,94). Most important, BP have a higher risk to die during the inpatient stay (43.5 % vs. 32.4 %, p<0.001). Conclusion: This data indicate that breathlessness is a risk factor for a higher symptom burden, more help needed with ADL and a lower survival. Breathless patients need more attention, better symptom control beyond breathlessness and advance care planning in order to improve their quality of life.