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Cited by 201Palliative Care and End-of-Life IssuesPalliative and Oncologic CarePain Management and Opioid Use

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

Open access
Farquhar, Morag C, Prevost, A Toby, McCrone, Paul, Brafman-Price, Barbara, Bentley, Allison, Higginson, Irene J, Todd, Chris, Booth, Sara·2014·BMC Medicine
DOI 10.1186/s12916-014-0194-2PMC PMC4222435
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Abstract

BACKGROUND: Breathlessness is common in advanced cancer. The Breathlessness Intervention Service (BIS) is a multi-disciplinary complex intervention theoretically underpinned by a palliative care approach, utilising evidence-based non-pharmacological and pharmacological interventions to support patients with advanced disease. We sought to establish whether BIS was more effective, and cost-effective, for patients with advanced cancer and their carers than standard care. METHODS: A single-centre Phase III fast-track single-blind mixed-method randomised controlled trial (RCT) of BIS versus standard care was conducted. Participants were randomised to one of two groups (randomly permuted blocks). A total of 67 patients referred to BIS were randomised (intervention arm n = 35; control arm n = 32 received BIS after a two-week wait); 54 completed to the key outcome measurement. The primary outcome measure was a 0 to 10 numerical rating scale for patient distress due to breathlessness at two-weeks. Secondary outcomes were evaluated using the Chronic Respiratory Questionnaire, Hospital Anxiety and Depression Scale, Client Services Receipt Inventory, EQ-5D and topic-guided interviews. RESULTS: BIS reduced patient distress due to breathlessness (primary outcome: -1.29; 95% CI -2.57 to -0.005; P = 0.049) significantly more than the control group; 94% of respondents reported a positive impact (51/53). BIS reduced fear and worry, and increased confidence in managing breathlessness. Patients and carers consistently identified specific and repeatable aspects of the BIS model and interventions that helped. How interventions were delivered was important. BIS legitimised breathlessness and increased knowledge whilst making patients and carers feel 'not alone'. BIS had a 66% likelihood of better outcomes in terms of reduced distress due to breathlessness at lower health/social care costs than standard care (81% with informal care costs included). CONCLUSIONS: BIS appears to be more effective and cost-effective in advanced cancer than standard care. TRIAL REGISTRATION: RCT registration at ClinicalTrials.gov NCT00678405 (May 2008) and Current Controlled Trials ISRCTN04119516 (December 2008).

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  • The BTF model was developed by the Cambridge Breathlessness Intervention Service (CBIS), a multidisciplinary home-based intervention of proven cost-effectiveness.

    “This empirical model was developed by the Cambridge Breathlessness Intervention Service (CBIS), a multidisciplinary home-based intervention of proven cost-effectiveness.”

    From The Breathing, Thinking, Functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease (2017) · cites this paper as [25]

    Box 1 and the Methods describe BIS as a multidisciplinary intervention delivered predominantly in patients’ homes. The Conclusions say BIS appears cost-effective compared with standard care for patients with breathlessness in advanced cancer, but the paper does not identify a BTF model or say that CBIS developed it. “Proven cost-effectiveness” also states the finding more strongly and broadly than the paper does. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Breathlessness services providing predominantly non-pharmacological approaches are effective, cost-effective, and improve distress from breathlessness, mastery, quality of life, and survival.

    “Such services provide a brief, cost-effective intervention that impacts positively on distress from breathlessness, mastery, quality of life, and even survival.”

    From The Breathing, Thinking, Functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease (2017) · cites this paper as [25]

    The Results and Discussion report that the Breathlessness Intervention Service reduced distress due to breathlessness and was likely cost-effective on that outcome; participants also described greater confidence in managing breathlessness. But the Results found no significant improvement in measured mastery or quality-of-life domains, and the copy provides no evidence of improved survival (searched: survival). (LLM, conf=0.90)

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2 of the 38 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. [17]Booth S Moffat C Burkin J The Cambridge BIS Manual – Building a Breathlessness Intervention Service 2012 Cambridge Cambridge University Hospitals NHS Foundation Trust

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Authors
Farquhar, M. C., Prevost, A. T., McCrone, P., Brafman-Price, B., Bentley, A., Higginson, I. J., Todd, C., & Booth, S.
Affiliations
  • University of Cambridge (GB)
  • King's College London (GB)
  • Cambridge University Hospitals NHS Foundation Trust (GB)
  • University of Manchester (GB)
Corresponding author
Farquhar, Morag C
ORCID
Venue
BMC Medicine
Publisher
Springer Science and Business Media LLC
Published
2014-10-31
Volume
12
Issue
1
Pages
194-194
ISSN
1741-7015 (ISSN-L)
DOI
10.1186/s12916-014-0194-2
PMC
PMC4222435
OpenAlex
W2070706399
Cited by
201
References
38
Citations by year
2026: 5 · 2025: 8 · 2024: 12 · 2023: 5 · 2022: 21 · 2021: 16 · 2020: 22 · 2019: 24 · 2018: 19 · 2017: 21 · 2016: 32 · 2015: 14 · 2014: 1 · 2013: 1
FWCI
22.56
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • UEA Digital Repository (University of East Anglia) (acceptedVersion)
  • Apollo (University of Cambridge) (submittedVersion, cc-by)
  • Research Portal (King's College London) (submittedVersion, cc-by)
  • Research Explorer (The University of Manchester) (submittedVersion)
  • Spiral (Imperial College London) (submittedVersion, cc-by)
Funders
  • Macmillan Cancer Support
  • National Institute for Health and Care Research (PB-PG-0107-11134, NF-SI-0611-10209)
  • University of Cambridge
  • King's College London
  • Cambridge University Hospitals
  • Research for Patient Benefit Programme
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Keywords
dyspnea, advanced cancer, palliative care, caregivers, cost-effectiveness, non-pharmacological treatment, anxiety and depression, informal care costs
MeSH terms
Adult, Aged, Aged, 80 and over, Anxiety, Cost-Benefit Analysis, Dyspnea, Female, Humans, Male, Middle Aged, Neoplasms, Occupational Therapy, Palliative Care, Surveys and Questionnaires, Single-Blind Method, Caregivers, Health Care Costs, Outcome Assessment, Health Care, Physical Therapy Modalities

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