Breathlessness Patterns in Patients With Cancer, COPD and Heart Failure: an fMRI Feasibility Study

Inclusion Criteria * Age ≥ 18 years and * Followed by the outpatient palliative care clinic of the Geneva University Hospitals, Switzerland (HUG) and * Breathlessness at rest \> 2 and \< 8 on the NRS (numeric rating scale 0 to 10) and * Persistent breathlessness (persistent dyspnea for \> 3 weeks despite adequate and maximal medication according to the pathology) and * In a stable clinical condition, i.e., without an episode of acute cardiac, respiratory, and/or neurological failure leading to hospitalization in the previous 4 weeks and * Diagnosis of either HF stage NYHA III-IV, or COPD with dyspnea on the modified MRC scale grade 3-4, or oncological disease with primary or secondary pulmonary involvement Inclusion Criteria for Healthy Volunteers (Control Group) * Age ≥ 18 years and * No respiratory symptoms: dyspnea, cough, wheezing and * No known pulmonary, cardiac, or oncological disease and * Smoking status \< 10 pack-years and * No contraindication to fMRI (Appendix 3) and * Ability to lie flat (supine position) and * No diagnosed psychiatric illness (severe depression, severe anxiety, psychosis, other) or antipsychotic treatment deemed a contraindication for fMRI based on physician judgement and * No neurological disorders according to neurological assessment, including diagnosed dementia (frontotemporal dementia, Alzheimer's disease, etc.), brain pathology (tumor, stroke, Parkinson's disease, etc.), or epilepsy and * No claustrophobia, acrophobia, photophobia, severe hearing loss, and/or severe visual deficit and * No contraindication to IVR (migraines, photosensitive epilepsy, vertigo) Exclusion Criteria * Breathlessness at rest ≥ 8 on the NRS (numeric rating scale 0 to 10) * Contraindication to fMRI * Inability to lie flat (supine position) * Diagnosed psychiatric illness (severe depression, severe anxiety, psychosis, other) or antipsychotic treatment deemed a contraindication for fMRI based on physician judgement * Neurological disorders according to neurological assessment, including diagnosed dementia (frontotemporal dementia, Alzheimer's disease, etc.), brain pathology (tumor, stroke, Parkinson's disease, etc.), or epilepsy * Presence of claustrophobia, acrophobia, photophobia, severe hearing loss, and/or severe visual deficit * Contraindication to IVR (migraines, photosensitive epilepsy, vertigo)