Non-invasive ventilation – palliative care for an oncology patient

Patients with neoplastic lung disease experience a decreased quality of life due to progressive respiratory dysfunction. The inclusion of non-invasive ventilation (NIV) in the management plan of these patients has been effective in relieving symptoms of acute respiratory failure, reducing respiratory effort and increasing sleep quality. A 48-year-old patient diagnosed with pulmonary adenocarcinoma (radio-chemo-treated) and COPD presented to the ER with the complaints of thoracalgia, dyspnoea and daytime fatigue. Initial tests showed hypoxemic respiratory failure, mild obstructive sleep apnoea syndrome and right medium pleural effusion. CPAP therapy was initiated but not tolerated by the patient and, therefore, we switched to NIV – BPAP (spontaneous mode) with satisfactory results. The literature indicates that NIV therapy has proved superior to oxygen therapy in cancer patients, relieving dyspnoea in patients with hypoxemic respiratory failure (regardless of PaCO₂ level). Moreover, NIV-treated patients required lower doses of opioids and reported an improved quality of life.