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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 accessAbstract
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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“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]
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“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]
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Cites
The Hospital Anxiety and Depression Scale
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Economic Evaluation in Clinical Trials
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Normative data for the HADS from a large non-clinical sample
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“30 SD of the norm distribution [35] and depression was comparable (higher by 0.”
Background
Research works printed but not linked: 2
- Booth S, Moffat C, Burkin J: The Cambridge BIS Manual - Building a Breathlessness Intervention Service. 2012, Cambridge University Hospitals NHS Foundation Trust, Cambridge
- Curtis L: Unit Costs of Health and Social Care. 2012, PSSRU, Canterbury
Cited by
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FERRELL, B. R., Temel, J. S., Temin, S., Alesi, E. R., Balboni, T. A., Basch, E., Firn, J. I., Paice, J. A., Peppercorn, J. M., Phillips, T., et al. (2017) · Journal of Clinical Oncology · doi:10.1200/jco.2016.70.1474 · Cited by 2,148
Association Between Palliative Care and Patient and Caregiver Outcomes
Kavalieratos, D., Corbelli, J. A., Zhang, D., Dionne-Odom, J. N., Ernecoff, N. C., Hanmer, J., Hoydich, Z., Ikejiani, D. Z., Klein‐Fedyshin, M., Zimmermann, C., et al. (2016) · JAMA · doi:10.1001/jama.2016.16840 · Cited by 1,183
Towards an expert consensus to delineate a clinical syndrome of chronic breathlessness
Johnson, M. J., Yorke, J., Hansen-Flaschen, J. H., Lansing, R., Ekström, M. P., Similowski, T., & Currow, D. C. (2017) · European Respiratory Journal · doi:10.1183/13993003.02277-2016 · Cited by 297
Spathis, A., Booth, S., Moffat, C., Hurst, R., Ryan, R., Chin, C., & Burkin, J. (2017) · npj Primary Care Respiratory Medicine · doi:10.1038/s41533-017-0024-z · Cited by 226
“This empirical model was developed by the Cambridge Breathlessness Intervention Service (CBIS), a multidisciplinary homebased intervention of proven cost-effectiveness.(25) Each of the three domains is supported by research evidence, as described above, and the model is theoretically underpinned by a ‘vicious flower’…”
MethodSelf-citationBajwah, S., Oluyase, A. O., Yi, D., Gao, W., Evans, C., Grande, G., Todd, C. J., Costantini, M., Murtagh, F. E., & Higginson, I. J. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012780.pub2 · Cited by 249
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Metadata
- 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
- Published
- 2014-10-31
- Volume
- 12
- Issue
- 1
- Pages
- 194-194
- ISSN
- 1741-7015 (ISSN-L)
- 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
- FWCI
- 22.56
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- 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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