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What is Breathlessness?

Breathlessness is an unpleasant sensation of uncomfortable, rapid or difficult breathing. It may come on suddenly or gradually over a period of time. The reason for breathlessness is that your body needs more oxygen than it is getting so you breathe faster.

Breathlessness and Cancer

There are a number of possible causes of breathlessness. Following a diagnosis of cancer, fear, stress and anxiety are very common natural reactions. They can cause people to breathe too fast and to take shallow breaths from the top of your lungs, rather than your lower chest. This can sometimes make you feel more breathless, which can lead to a feeling of a panic attack.

Sometimes cancer affecting the lungs can be a cause of breathlessness, it may be a primary lung cancer (where the cancer has started in the lungs) or a secondary cancer that has spread to the lung from another part of the body. Treatments are available which may help shrink the tumour and relieve breathlessness caused by cancer.

A few other examples include chest infections where the phlegm in the airways can make you feel breathless. Weakened muscles and pain that is poorly controlled can make it difficult to breathe comfortably.

Breathlessness can be distressing and it can affect several areas of your life. However, there are many things that can relieve or help you manage breathlessness. Some people prefer some techniques over others – there is no right or wrong way of coping. The most important thing is to find what works best for you in each situation. Here are some ideas below:

1. Prioritise: Consider which activities are important to you each day and prioritise the activities for which you would like to conserve your energy. Try to cut out unnecessary tasks in order to conserve your energy and spread out activities in the day. For example, do five minutes of ironing six times a day, instead of 30 mins at one time.
2. Plan: Organize your activities as effectively as possible in order to conserve as much energy as possible. Try not to do too much in any one day and plan your activities for the week if at all possible.
3. Pace: It is important to balance periods of activity with periods of rest (i.e. take your time when walking and take frequent rests if you need to).
4. Position: Work out a position that is comfortable for you and practice doing this to help yourself.
   Try these positions to see if they work for you:
   High side lying Head and chest are supported by the arm and pillows Top leg is bent up
   Lower arm is bent under the pillow Relaxed sitting position
   Sit on a chair Elbows are rested on thighs Hands and wrists are relaxed
   Relaxed standing Lean against a wall
   Relaxed forward slightly, loosening neck, shoulders and arms NB. Do not lean too far forward and fall Forward leaning standing Lean forward against a banister
   Relax forward slightly, loosening neck, shoulders and arms
   NB. Do not lean too far forward and fall
5. Permission: Give yourself permission not to do activities which make you breathless and tired. Try and change your way of thinking, instead of ‘I must’ or ‘I ought’ try ‘I choose to do’ or ‘I wish to do’ instead. For example, “I should ring Sam” to “I could ring Sam”.
6. Psychological - Breathlessness can often make you feel low in mood. You may feel guilty and feel that you don’t want to be a burden. Maybe everything seems too much effort and that you can’t be bothered to go out. However, have you considered some alternative thoughts such as what small successes you have achieved and what other people see as your strengths? It is important to be kind to yourself and reward yourself for your successes – however small they seem.
7. Relaxation – relaxation can help to calm the body down. There are a number of different skills you can use. For example, deep breathing, muscle relaxation exercises, listening to relaxing music or imagining yourself somewhere safe and calm. Some people find physical activity is more relaxing for them. Please refer to the physical activity booklet.
8. Practical – If you are finding your breathlessness is causing difficulties managing at home there may be equipment that can help you complete your activities more independently. Your GP can refer you to your local occupational therapist or you can speak to a member of your oncology team.

Sources of Support

If you would like further support for coping with your breathlessness you can find this from the following services:

Your GP (you may be referred to the surgery’s counselling service).

Macmillan Cancer Support: www.macmillan.org.uk or 0808 808 0000.

Tenovus: www.tenovus.org.uk or 0808 808 1010.

Leigh Porter, Velindre Patient and Carer Information and Support Co-ordinator: For information on support services in your local area – 029 20196132.

Velindre has programmes aimed to help you to manage your breathlessness and live with feelings of uncertainty.

Your Consultant or Clinical Nurse Specialist can provide you information about the services available to you and request a referral to programmes or Clinical Psychology and Counselling team at Velindre Cancer Centre.

This leaflet was written by health professionals. The information contained in this leaflet is evidence based. It has been approved by doctors, nurses and patients. It is reviewed and updated every 2 years.

Original version prepared 2014.

The Role of Physical Activity

This leaflet aims to provide you with some information about the importance of physical activity and ways of increasing your activity levels. In the past, adults with cancer were often told to rest during treatment. However, we now know
that being active will help you manage some of the side effects of cancer and / or its treatment(s).

There are lots of benefits to keeping active during and after cancer treatment, both for your body and your mind. Activity can help reduce fatigue, increase your appetite, build muscle and bone strength, help your heart, keep you fit and help you maintain a healthy weight. Activity can also help you manage stress, anxiety and low mood. There is some evidence that for some people being active can reduce the risk of cancer coming back in the future. However, the thought of becoming active can be overwhelming, particularly if you have not been active before or for some time. It can be difficult to know where to start or you may worry about your ability to return to your previous activity levels. 

How Much Activity Should I Do?

It can be difficult to know how much and the type of activity you should be doing. It is suggested that all adults should try and do:

150 minutes (2 hours 30 minutes) of moderate intensity
activity every week.

This may sound like a lot; but the activity does not have to be done all at the same time. For example:

30 minutes of activity - 5 times per week.

If you are just starting to increase your activity levels or are having treatment, you may want to do shorter times and do them over the day. For example:

Three 10 minute sessions in one day

It can also be hard to know how intense your activity levels need to be. As a rule, moderate intensity activity should make you feel a little warmer, make your heart beat a little quicker and breathing a little faster, but you should still be able to hold a conversation. 

Top Tips for Getting Active and Staying Active

There are many ways that you can become more active. Here are some ideas on how to be more active:

1. Try not to sit and lie down for a long time in the day - do small amounts of activity throughout the day.
    
2. Build activity into things you do every day, for example:
   • Do some housework.
   • Take the stairs rather than the lift.
   • Get off the bus a stop early and walk the rest of the journey home.
   • Play with your children, grandchildren or the dog.
   • Do some gardening.
     
     Remember that these things count towards our daily amount of activity and can help our health in the same way as swimming, running and cycling. Can you think of other ways of building activity into your daily routine?
      
3. Make goals that you can achieve. If you have never run before or for a long time, start by running for five minutes, not trying to run a marathon. As the activity gets easier, set a new goal.
    
4. Write down when you do an activity in a diary. This will help you to remain motivated and see what you have achieved.
    
5. Gradually build up your activity levels. Start with small amounts of activity, slowly increasing it over days and weeks.
    
6. Do something that you enjoy. You are more likely to stick to your activity plan and achieve your goals if you do an activity that you enjoy.
    
7. Trying a new activity or changing your activities will help to keep your interest and enjoyment.
    
8. Don’t be hard on yourself if you are having a bad day, or if you are not going as quickly as you would like. Reward yourself when you achieve your goal.
    
9. You don’t have to do it alone – asking family or friends to do some activities with you can help to keep you motivated. You may also want to think about joining a sports club or group. 
    
10. Remember that you can ask for advice from your key-worker or GP. The National Exercise Referral Scheme can help you make an activity plan that works for you. They are at your local leisure centre. Speak to your GP, specialist nurse or key-worker if you are interested in being referred. 

Sources of Support

The following services can give you more information or
help on staying active:

• Let’s Walk Cymru 02920 646890 or www.ramblers.org.uk/letswalkcymru
• National Exercise Referral Scheme - www.wlga.gov.uk/ners
• Leigh Bodilly, Velindre Patient and Carer Information and Support Co-ordinator: For information on support services in your local area – 029 20196132.
• Macmillan Cancer Support: www.macmillan.org.uk or 0808 808 00 00. For further physical activity information and resources – please visit www.macmillan.org.uk/movemore

This leaflet was written by health professionals. The information contained in this leaflet is evidence based. It has been approved by doctors, nurses and patients. It is reviewed and updated every 2 years.

This leaflet offers tips and advice on how to maintain a healthy bladder and bowel

• Aim to drink 1.5-2 litres of fluid everyday spread throughout the day  
• Do not restrict fluids as this will make your urine more concentrated which can irritate your bladder and make you want to go more frequently
• Limit caffeine, alcohol and carbonated drinks 
• Aim to go to the toilet to pass urine every 2-3 hours 
• Take your time and try to relax when passing urine and ensure your bladder has emptied completely
• Try to avoid ‘just in case’ visits to the toilet – your bladder may become lazy otherwise
• If you wake frequently during the night to empty your bladder try to limit fluids 2-3 hours before going to bed 
• Do not delay opening your bowels when you have the urge to do so
• Try to raise your feet on a step when you sit on the toilet to open your bowels
• Eat a well-balanced diet with at least 5 daily portions of fruit and vegetables  
• Lead a positive lifestyle – stop smoking and aim to maintain a healthy weight with a BMI of 25 or less

Version 1.0 April 2020