• J Pain Symptom Manage · Jul 2020

    Multicenter Study

    Association between heart rate and reversibility of the symptom, refractoriness to palliative treatment, and survival in dyspneic cancer patients.

    • Ichiro Mori, Isseki Maeda, Tatsuya Morita, Satoshi Inoue, Masayuki Ikenaga, Ryuichi Sekine, Takashi Yamaguchi, Takeshi Hirohashi, Tsukasa Tajima, and Hiroaki Watanabe.
    • Gratia Hospital Hospice, Minoh, Osaka, Japan. Electronic address: mori.ichi.mail@gmail.com.
    • J Pain Symptom Manage. 2020 Jul 1; 60 (1): 87-93.

    ContextDyspnea is one of the most distressing symptoms for terminally ill cancer patients and a predictor of poor prognosis. Identification of simple clinical signs, such as heart rate, indicating clinical course of each patient is of value.ObjectivesTo explore the potential association between heart rate and reversibility of the symptom, treatment response to palliative intervention, and survival in terminally ill cancer patients with dyspnea at rest.MethodsThis is a secondary analysis of a multicenter prospective cohort study of patients with advanced cancer to validate multiple prognostic tools. In the patients with dyspnea at rest at the baseline, we examined a potential association between heart rate and the reversibility of dyspnea and refractoriness to palliative treatment using logistic regression analysis. Survivals were compared using the Cox proportional hazards model among four groups with different levels of the heart rate (≤74, 75-84, 85-97, and ≥98).ResultsA total of 2298 patients were enrolled, and 418 patients (18%) had dyspnea at rest. Reversibility of dyspnea was significantly higher in the patients with lower heart rate (P for trend = 0.008), and the refractoriness to palliative treatment tended to be higher in the patients with higher heart rate (P for trend = 0.101). The median survival for each heart rate quartile groups was significantly higher in the lower heart rate group (24 vs. 21 vs. 14 vs. 9 days; heart rate ≤74, 75-84, 85-97, and ≥98, respectively; log-rank P < 0.001).ConclusionHeart rate may help clinicians to make the prediction of the patient's clinical course more accurate.Copyright © 2020 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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