Skip to main content
Top
Published in: Supportive Care in Cancer 11/2013

01-11-2013 | Original Article

Comparison of modified Borg scale and visual analog scale dyspnea scores in predicting re-intervention after drainage of malignant pleural effusion

Authors: Rogier C. Boshuizen, Andrew D. Vincent, Michel M. van den Heuvel

Published in: Supportive Care in Cancer | Issue 11/2013

Login to get access

Abstract

Background

Dyspnea is the most common symptom in patients with malignant pleural effusion (MPE). Treatment decisions are primarily based on the perception of dyspnea severity.

Aims

To study dyspnea perception following therapeutic thoracentesis using the visual analog scale (VAS) dyspnea score and modified Borg scale (MBS). To investigate whether patient reported outcome (PRO) measures can predict pleural re-interventions.

Patients and methods

Consecutive patients presenting with symptomatic MPE and planned for therapeutic thoracentesis were asked to complete MBS and VAS dyspnea scores (both at rest and during exercise) daily for 14 consecutive days. Physicians, unaware of the results of these PRO measures, decided on the necessity of a re-intervention, according to routine care. PRO measures were analyzed and correlated with performed re-interventions and the volume of removed fluid.

Results

Forty-nine out of 64 consecutive patients returned the diaries. Twenty-eight patients (57 %) had a re-intervention within 30 days. Patients who required a re-intervention reported significantly higher MBS than patients who did not. The extent of increase in MBS during exercise was related to the need for re-intervention. Regarding the MBS during exercise, median time to maximal relief was 2 days. Re-intervention was required sooner when larger volumes were drained.

Conclusion

Patient reported outcomes are useful tools to assess treatment effect of therapeutic thoracentesis. Median time to maximal relief is 2 days. MBS rather than VAS dyspnea score appears to be more prognostic for repeat pleural drainage within 30 days.
Appendix
Available only for authorised users
Literature
1.
go back to reference Light RW, Lee YC (2013) Textbook of pleural diseases, 2nd edn. Hodder Arnold, London, pp 41–43 Light RW, Lee YC (2013) Textbook of pleural diseases, 2nd edn. Hodder Arnold, London, pp 41–43
2.
go back to reference Johnston WW (1985) The malignant pleural effusion. A review of cytopathologic diagnoses of 584 specimens from 472 consecutive patients. Cancer 56:905–909PubMedCrossRef Johnston WW (1985) The malignant pleural effusion. A review of cytopathologic diagnoses of 584 specimens from 472 consecutive patients. Cancer 56:905–909PubMedCrossRef
3.
go back to reference Villena GV, Ferrer SJ, Hernandez BL, de Pablo GA, Perez RE, Rodriguez PF, Romero CS, Salvatierra VA, Valdes CL (2006) [Diagnosis and treatment of pleural effusion]. Arch Bronconeumol 42:349–372CrossRef Villena GV, Ferrer SJ, Hernandez BL, de Pablo GA, Perez RE, Rodriguez PF, Romero CS, Salvatierra VA, Valdes CL (2006) [Diagnosis and treatment of pleural effusion]. Arch Bronconeumol 42:349–372CrossRef
4.
go back to reference Rodriguez-Panadero F, Borderas NF, Lopez MJ (1989) Pleural metastatic tumours and effusions. Frequency and pathogenic mechanisms in a post-mortem series. Eur Respir J 2:366–369PubMed Rodriguez-Panadero F, Borderas NF, Lopez MJ (1989) Pleural metastatic tumours and effusions. Frequency and pathogenic mechanisms in a post-mortem series. Eur Respir J 2:366–369PubMed
5.
go back to reference Chernow B, Sahn SA (1977) Carcinomatous involvement of the pleura: an analysis of 96 patients. Am J Med 63:695–702PubMedCrossRef Chernow B, Sahn SA (1977) Carcinomatous involvement of the pleura: an analysis of 96 patients. Am J Med 63:695–702PubMedCrossRef
6.
go back to reference Morgensztern D, Waqar S, Subramanian J, Trinkaus K, Govindan R (2012) Prognostic impact of malignant pleural effusion at presentation in patients with metastatic non-small cell lung cancer. J Thorac Oncol 7:1485–1489PubMedCrossRef Morgensztern D, Waqar S, Subramanian J, Trinkaus K, Govindan R (2012) Prognostic impact of malignant pleural effusion at presentation in patients with metastatic non-small cell lung cancer. J Thorac Oncol 7:1485–1489PubMedCrossRef
7.
go back to reference Erasmus JJ, Patz EF Jr (1999) Treatment of malignant pleural effusions. Curr Opin Pulm Med 5:250–255PubMedCrossRef Erasmus JJ, Patz EF Jr (1999) Treatment of malignant pleural effusions. Curr Opin Pulm Med 5:250–255PubMedCrossRef
8.
go back to reference Roberts ME, Neville E, Berrisford RG, Antunes G, Ali NJ (2010) Management of a malignant pleural effusion: British thoracic society pleural disease guideline 2010. Thorax 65(Suppl 2):ii32–ii40PubMedCrossRef Roberts ME, Neville E, Berrisford RG, Antunes G, Ali NJ (2010) Management of a malignant pleural effusion: British thoracic society pleural disease guideline 2010. Thorax 65(Suppl 2):ii32–ii40PubMedCrossRef
9.
go back to reference Shumway NM, Wilson RL, Howard RS, Parker JM, Eliasson AH (2008) Presence and treatment of air hunger in severely ill patients. Respir Med 102:27–31PubMedCrossRef Shumway NM, Wilson RL, Howard RS, Parker JM, Eliasson AH (2008) Presence and treatment of air hunger in severely ill patients. Respir Med 102:27–31PubMedCrossRef
10.
go back to reference Hareendran A, Leidy NK, Monz BU, Winnette R, Becker K, Mahler DA (2012) Proposing a standardized method for evaluating patient report of the intensity of dyspnea during exercise testing in COPD. Int J Chron Obstruct Pulmon Dis 7:345–355PubMedCrossRef Hareendran A, Leidy NK, Monz BU, Winnette R, Becker K, Mahler DA (2012) Proposing a standardized method for evaluating patient report of the intensity of dyspnea during exercise testing in COPD. Int J Chron Obstruct Pulmon Dis 7:345–355PubMedCrossRef
11.
go back to reference Martinez JA, Straccia L, Sobrani E, Silva GA, Vianna EO, Filho JT (2000) Dyspnea scales in the assessment of illiterate patients with chronic obstructive pulmonary disease. Am J Med Sci 320:240–243PubMedCrossRef Martinez JA, Straccia L, Sobrani E, Silva GA, Vianna EO, Filho JT (2000) Dyspnea scales in the assessment of illiterate patients with chronic obstructive pulmonary disease. Am J Med Sci 320:240–243PubMedCrossRef
12.
go back to reference Bausewein C, Farquhar M, Booth S, Gysels M, Higginson IJ (2007) Measurement of breathlessness in advanced disease: a systematic review. Respir Med 101:399–410PubMedCrossRef Bausewein C, Farquhar M, Booth S, Gysels M, Higginson IJ (2007) Measurement of breathlessness in advanced disease: a systematic review. Respir Med 101:399–410PubMedCrossRef
13.
go back to reference Davies HE, Mishra EK, Kahan BC, Wrightson JM, Stanton AE, Guhan A, Davies CW, Grayez J, Harrison R, Prasad A, Crosthwaite N, Lee YC, Davies RJ, Miller RF, Rahman NM (2012) Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion: the TIME2 randomized controlled trial. JAMA 307:2383–2389PubMedCrossRef Davies HE, Mishra EK, Kahan BC, Wrightson JM, Stanton AE, Guhan A, Davies CW, Grayez J, Harrison R, Prasad A, Crosthwaite N, Lee YC, Davies RJ, Miller RF, Rahman NM (2012) Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion: the TIME2 randomized controlled trial. JAMA 307:2383–2389PubMedCrossRef
14.
go back to reference Putnam JB Jr, Light RW, Rodriguez RM, Ponn R, Olak J, Pollak JS, Lee RB, Payne DK, Graeber G, Kovitz KL (1999) A randomized comparison of indwelling pleural catheter and doxycycline pleurodesis in the management of malignant pleural effusions. Cancer 86:1992–1999PubMedCrossRef Putnam JB Jr, Light RW, Rodriguez RM, Ponn R, Olak J, Pollak JS, Lee RB, Payne DK, Graeber G, Kovitz KL (1999) A randomized comparison of indwelling pleural catheter and doxycycline pleurodesis in the management of malignant pleural effusions. Cancer 86:1992–1999PubMedCrossRef
15.
go back to reference Marcondes BF, Vargas F, Paschoal FH, Cartaxo AM, Teixeira LR, Genofre EH, Onishi R, Skomro R, Lorenzi-Filho G (2012) Sleep in patients with large pleural effusion: impact of thoracentesis. Sleep Breath 16:483–489PubMedCrossRef Marcondes BF, Vargas F, Paschoal FH, Cartaxo AM, Teixeira LR, Genofre EH, Onishi R, Skomro R, Lorenzi-Filho G (2012) Sleep in patients with large pleural effusion: impact of thoracentesis. Sleep Breath 16:483–489PubMedCrossRef
16.
go back to reference Cartaxo AM, Vargas FS, Salge JM, Marcondes BF, Genofre EH, Antonangelo L, Marchi E, Teixeira LR (2011) Improvements in the 6-min walk test and spirometry following thoracentesis for symptomatic pleural effusions. Chest 139:1424–1429PubMedCrossRef Cartaxo AM, Vargas FS, Salge JM, Marcondes BF, Genofre EH, Antonangelo L, Marchi E, Teixeira LR (2011) Improvements in the 6-min walk test and spirometry following thoracentesis for symptomatic pleural effusions. Chest 139:1424–1429PubMedCrossRef
17.
go back to reference Wilson RC, Jones PW (1989) A comparison of the visual analogue scale and modified Borg scale for the measurement of dyspnoea during exercise. Clin Sci (Lond) 76:277–282 Wilson RC, Jones PW (1989) A comparison of the visual analogue scale and modified Borg scale for the measurement of dyspnoea during exercise. Clin Sci (Lond) 76:277–282
18.
go back to reference Barbera L, Taylor C, Dudgeon D (2010) Why do patients with cancer visit the emergency department near the end of life? CMAJ 182:563–568PubMedCrossRef Barbera L, Taylor C, Dudgeon D (2010) Why do patients with cancer visit the emergency department near the end of life? CMAJ 182:563–568PubMedCrossRef
19.
go back to reference Wallace EM, Walsh J, Conroy M, Cooney MC, Twomey F (2012) Why do palliative care patients present to the emergency department? Avoidable or unavoidable? Am J Hosp Palliat Care 30(3):253–256PubMedCrossRef Wallace EM, Walsh J, Conroy M, Cooney MC, Twomey F (2012) Why do palliative care patients present to the emergency department? Avoidable or unavoidable? Am J Hosp Palliat Care 30(3):253–256PubMedCrossRef
20.
go back to reference Morris NR, Sabapathy S, Adams L, Kingsley RA, Schneider DA, Stulbarg MS (2007) Verbal numerical scales are as reliable and sensitive as visual analog scales for rating dyspnea in young and older subjects. Respir Physiol Neurobiol 157:360–365PubMedCrossRef Morris NR, Sabapathy S, Adams L, Kingsley RA, Schneider DA, Stulbarg MS (2007) Verbal numerical scales are as reliable and sensitive as visual analog scales for rating dyspnea in young and older subjects. Respir Physiol Neurobiol 157:360–365PubMedCrossRef
21.
go back to reference von LA, Dahme B (2005) Differentiation between the sensory and affective dimension of dyspnea during resistive load breathing in normal subjects. Chest 128:3345–3349CrossRef von LA, Dahme B (2005) Differentiation between the sensory and affective dimension of dyspnea during resistive load breathing in normal subjects. Chest 128:3345–3349CrossRef
22.
go back to reference von LA, Ambruzsova R, Nordmeyer S, Jeske N, Dahme B (2006) Sensory and affective aspects of dyspnea contribute differentially to the Borg scale's measurement of dyspnea. Respiration 73:762–768 von LA, Ambruzsova R, Nordmeyer S, Jeske N, Dahme B (2006) Sensory and affective aspects of dyspnea contribute differentially to the Borg scale's measurement of dyspnea. Respiration 73:762–768
Metadata
Title
Comparison of modified Borg scale and visual analog scale dyspnea scores in predicting re-intervention after drainage of malignant pleural effusion
Authors
Rogier C. Boshuizen
Andrew D. Vincent
Michel M. van den Heuvel
Publication date
01-11-2013
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 11/2013
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-013-1895-3

Other articles of this Issue 11/2013

Supportive Care in Cancer 11/2013 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine