Only 55 days to #EAPC2020 … The 11th World Research Congress of the European Association for Palliative Care which, for the first time ever, will take place online. Plenary and invited talks and free communication sessions will be pre-recorded and available on demand from 21 September to 31 January 2021.
One of our plenary speakers is Professor Claudia Bausewein, Director of the Department of Palliative Medicine at Munich University Hospital, who will present data on the effectiveness of Munich Breathlessness Service, a specialized intervention for patients suffering from breathlessness in advanced disease in Germany. Ahead of the congress, Prof Claudia Bausewein and Dr Michaela Schunk, who led theBreathEase trial evaluating the service, give a glimpse of the plenary presentation.
Dr Michaela Schunk (left) and Prof Claudia Bausewein.
Many patients with advanced diseases such as COPD (chronic obstructive pulmonary disease), lung fibrosis, heart failure or cancer suffer from chronic breathlessness. This burdensome symptom not only affects them at the end of life but sometimes months and years before death. Initially, patients feel breathless when walking uphill or faster, later they feel breathless when leaving the house or going shopping. In more advanced disease they are even breathless at rest and when talking.
Management comprises primarily non-pharmacological measures such as breathing techniques, walking aids and a hand-held fan, and later in the disease trajectory drugs such as opioids. As one single intervention will not be sufficient to relieve breathlessness (1) and multidimensional approaches beyond the state-of-the-art management of the underlying disease are needed, specialist breathlessness services have been established over the past 20 years, starting in the UK, to support patients and relatives to better cope with their breathlessness.
The best-known services are the Cambridge Breathlessness Intervention Service developed by Dr Sara Booth and the Breathlessness Support Service in the Cicely Saunders Institute at King’s College London. Both services have been evaluated with randomised controlled trials (RCTs), demonstrating their effectiveness. (2, 3)
In 2015, we started the Munich Breathlessness Service (MBS), which is the first of its kind in Germany. Following the MRC Framework for Complex Interventions, we developed the service after exploring the needs of patients, caregivers and professionals which helped us to better understand how the service should be shaped in the German healthcare system. (4) Our model comprises two personal meetings with a palliative care physician and, if necessary, a respiratory physician. Between the two meetings, patients were attending up to four individualised physiotherapy sessions. Overall, the intervention lasts about six weeks.
From the beginning, we were evaluating the effectiveness and cost-effectiveness of the MBS in a randomised controlled fast-track trial (BreathEase) with the intervention group getting immediate access to the service and the control group after eight weeks. We included 183 patients in the trial, which makes it the largest study so far testing a breathlessness service. Our data showed significant improvements in patients’ mastery of breathlessness and quality of life both measured on the Chronic Respiratory Disease Questionnaire. Although statistically significant, the change scores did not meet the threshold of the published minimum clinically important difference. Nevertheless, the findings are in line with the RCTs testing the Cambridge and the London services, supporting a consistently positive impact of the intervention. Our study demonstrates that this service works in a healthcare system with good access to respiratory specialists and across a wide range of patients with diverse advanced diseases.
We feel very honoured that our abstract demonstrating the results was chosen as one of the five best abstracts for the 11thEAPC World Research Congress. I am really looking forward to presenting the data in a plenary session at the online congress in October and hope that it will stimulate lots of discussion and interest!
Prof Claudia Bausewein will give her plenary lecture, ‘Effectiveness of a specialized intervention for patients suffering from breathlessness in advanced disease in Germany: a pragmatic fast-track randomized controlled trial (BreathEase)’ at the 11thEAPC Word Research Congress Online 7 to 9 October 2020. You can view her lecture from late September for a period of 12 weeks until January 2021 – at a time to suit you. Read the abstract of Prof Bausewein’s lecture, and all other congress presentations and posters, in the Book of Abstracts for the 11th EAPC World Research Congress, Palliative Medicine 2020 – available online from 21 September 2020 until 31 January 2021. Keep up to date at https://eapcresearchcongress2020.eu
Watch Claudia’s personal message about the congress on the EAPC YouTube channel.
References
- Higginson IJ. Refractory breathlessness: oxygen or room air? Lancet. 2010; 376 (9743): 746-8.
- Farquhar MC, Prevost AT, McCrone P, Brafman-Price B, Bentley A, Higginson IJ, et al. Is a specialist breathlessness service more effective and cost-effective for patients with advanced cancer and their carers than standard care? Findings of a mixed-method randomised controlled trial. BMC Medicine. 2014;12:194.
- Higginson IJ, Bausewein C, Reilly CC, Gao W, Gysels M, Dzingina M, et al. An integrated palliative and respiratory care service for patients with advanced disease and refractory breathlessness: a randomised controlled trial. The Lancet Respiratory Medicine,. 2014;2 (12):979-87.
- Schunk M, Schulze F, Bausewein C. What Constitutes Good Health Care for Patients with Breathlessness? Perspectives of Patients, Caregivers, and Health Care Professionals. J Palliat Med. 2019;22 (6):656-62.
View the EAPC blog for more posts about the 11th EAPC World Research Congress and Breathlessness.
More about the authors…
Professor Claudia Bausewein PhD MSc is Chair for Palliative Medicine at Ludwigs-Maximilians-University Munich and Director of the Department of Palliative Medicine at Munich University Hospital. She is clinical lead of the Munich Breathlessness Service. Contact Claudia by email. Dr Michaela Schunk MPH is a psychologist and health services researcher in the Department of Palliative Medicine and was leading the BreathEase trial.
It’s not too late to register… JOIN PALLIATIVE CARE SPECIALISTS FROM ACROSS THE WORLD AT #EAPC2020 –11th EAPC WORLD RESEARCH CONGRESS ONLINE 2020 – Interactive online sessions 7 to 9 October 2020 with on-demand content available from 21 September.
All registered delegates will receive a unique login to access the congress platform on the day we go live on 21 September – so keep an eye on your inbox!
Be a part of the first-ever EAPC World Research Congress Online. Learn and interact with leading researchers and chat with other registered delegates from the global palliative care community – all in the safety of your own home or office. CME accreditation available.Register here. Meet some of our plenary speakers on the EAPC YouTube channel.
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