If a terminal cancer patient is having problems breathing, what are the next steps?

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AndrewPutnamMD (Physician - Hospice / Palliative Care (Verified) ) - 12 / 12 / 2013

The answer to this question depends on how terminal you mean and what the goals of care are. If we have reached the point where the main goal is comfort, then the drugs of choice are 1) opioids (#1 choice is morphine) and 2) benzodiazepines (lorazepam etc.). There is good evidence that opioids help and we use lorazepam because it seems to help.

Increasing oxygen is not helpful at this point unless there is a specific goal to living a short time longer (family member is coming from far away etc.). Oxygen masks of any type are often uncomfortable and can cause claustrophobia at this time. Often the patient will take it off. They should rarely be started unless there is a good reason to try and extend life for a very short time. The patient in some cases may live a short time longer, but there is usually more suffering, which needs to be considered.

If the patient is short of breath but not close to dying, long-acting morphine (MS Contin, Oramorph etc.) can usually help the patient feel more comfortable.

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