Breathlessness, or feeling short of breath, is when a person perceives that it is harder to breathe. The medical term for this is dyspnea (pronounced ‘disp-nia’). People living with cancer may experience breathlessness for many reasons and anxiety can make this worse. Associated anxiety is particularly common towards the end of life.

Breathlessness can be caused by pain, lung disease, cardiac disease, exercise, anxiety and more. It may be treatable, for example with analgesia (painkillers) where pain is a contributing factor, anxiety management or breathing exercises. Identifying the cause of breathlessness is important for successful management and sometimes new or sudden onset breathlessness should always be reported to an appropriate healthcare professional.

People experiencing breathlessness may benefit from specific breathing techniques from physiotherapists or occupational therapists who can assess and assist with breathing control and potential issues around dysfunctional breathing and anxiety management. Some people benefit from relaxation techniques to manage their breathlessness including visualisation or mindfulness. People who are at risk of developing breathlessness as a side effect of treatment (or due to the tumour site) may be taught coping strategies early (e.g. during prehabilitation) so that they can be practiced and known about when needed, rather than trying to learn coping strategies when the person is in a state of anxiety or distress.

Anxiety and panic attacks are physical and emotional responses to stress that can significantly impact a person’s breathing patterns. While these symptoms are often alarming and can mimic serious medical emergencies, they are frequently the result of the body’s natural “fight or flight” response. Understanding how psychological stress translates into physical respiratory symptoms is essential for managing these episodes effectively and knowing when a symptom might indicate an underlying clinical issue.

Breathlessness can be supported by physiotherapists, clinical nurse specialists and occupational therapists at registered and enhanced levels and by support workers in supportive and assistive levels of practice supervised by registered practitioners.

Rehabilitation Assessment for Breathlessness

• Full Blood Count/Thyroid Function Tests/biochemistry
• ECG
• Natriuretic peptide tests (NT-proBNP)
• Chest X-ray
• Spirometry ± reversibility with bronchodilators
• Lung function tests
• Fractional exhaled nitric oxide (FeNO)
• Patient Health Questionnaire (PHQ4)
• MRC Breathlessness Scale
• GP Physical Activity Questionnaire (GPPAQ)