Easing Breathlessness in Patients With Advanced Cancer

Along with fatigue and depression, dyspnea is a common symptom that affects many patients with cancer.¹ But while common, breathlessness can be both debilitating and very distressing for these patients.

A team of investigators directed by researchers from the Johns Hopkins Kimmel Cancer Center set out to review the existing research on nonpharmacologic interventions designed to help improve this distressing symptom in patients with advanced cancer and determine which ones seem to be the most effective.²

The team reviewed 29 randomized clinical trials that involved 2423 patients and found varying levels of effectiveness among the nonpharmacologic methods. The study was co-sponsored by the Agency for Healthcare Research and Quality (AHRQ), the American Society of Clinical Oncology (ASCO) and the Patient-Centered Outcomes Research Institute (PCORI).²

The team’s findings have been incorporated into a new comparative effectiveness review for AHRQ titled “Interventions for Breathlessness in Patients with Advanced Cancer,” a broader review that also incorporates pharmacologic interventions.³ 

Although some causes of breathlessness can be easily reversed, others may be harder to address, particularly in a very frail patient with advanced cancer. It may not be feasible to subject a very fragile patient with extensive disease to certain procedures. That’s why effective palliative strategies are so useful, explains Arjun Gupta, MD, chief medical oncology fellow at the Johns Hopkins University and lead author of the study.

“These patients are so vulnerable that no matter what we do, whether it be medication or nonpharmacological intervention, we don’t want the harms to outweigh the benefits,” Dr Gupta said.

Strategies With the Most Promise

The team investigated various types of nonpharmacologic interventions and determined that 4 strategies seemed to hold the most promise:

• Airflow and cooling interventions, such as using a fan
• Bilevel ventilation
• Integrative medicine techniques, such as acupressure or reflexology
• Multicomponent interventions, which might include behavioral or psychoeducational activities, as well as integrative medicine approaches

The first 2 can be broadly grouped into strategies that are suited to inpatient use, while the others are more suitable for longer-term, outpatient use, explains Dr Gupta.