TY - JOUR
T1 - Management of Dyspnea in Advanced Cancer
T2 - ASCO Guideline
AU - Hui, David
AU - Bohlke, Kari
AU - Bao, Ting
AU - Campbell, Toby C.
AU - Coyne, Patrick J.
AU - Currow, David C.
AU - Gupta, Arjun
AU - Leiser, Aliza L.
AU - Mori, Masanori
AU - Nava, Stefano
AU - Reinke, Lynn F.
AU - Roeland, Eric J.
AU - Seigel, Carole
AU - Walsh, Declan
AU - Campbell, Margaret L.
N1 - Funding Information:
Expert Panel and the ASCO Clinical Practice Guidelines Committee before publication. All funding for the administration of the guideline was provided by ASCO. Funding for the AHRQ systematic review was provided by the Patient-Centered Outcomes Research Institute (PCORI).
Funding Information:
The Expert Panel wishes to thank Drs Eduardo Bruera, DorAnne Donesky, Christine Miaskowski, Jamie Lesnock, and the Clinical Practice Guidelines Committee for their thoughtful reviews and insightful comments on this guideline. Arjun Gupta is supported by an American Society of Clinical Oncology (ASCO) Young Investigator Award.
Publisher Copyright:
Copyright © 2022 American Society of Clinical Oncology. All rights reserved.
PY - 2021/4/20
Y1 - 2021/4/20
N2 - PURPOSE To provide guidance on the clinical management of dyspnea in adult patients with advanced cancer. METHODS ASCO convened an Expert Panel to review the evidence and formulate recommendations. An Agency for Healthcare Research and Quality (AHRQ) systematic review provided the evidence base for nonpharmacologic and pharmacologic interventions to alleviate dyspnea. The review included randomized controlled trials (RCTs) and observational studies with a concurrent comparison group published through early May 2020. The ASCO Expert Panel also wished to address dyspnea assessment, management of underlying conditions, and palliative care referrals, and for these questions, an additional systematic review identified RCTs, systematic reviews, and guidelines published through July 2020. RESULTS The AHRQ systematic review included 48 RCTs and two retrospective cohort studies. Lung cancer and mesothelioma were the most commonly addressed types of cancer. Nonpharmacologic interventions such as fans provided some relief from breathlessness. Support for pharmacologic interventions was limited. A meta-analysis of specialty breathlessness services reported improvements in distress because of dyspnea. RECOMMENDATIONS A hierarchical approach to dyspnea management is recommended, beginning with dyspnea assessment, ascertainment and management of potentially reversible causes, and referral to an interdisciplinary palliative care team. Nonpharmacologic interventions that may be offered to relieve dyspnea include airflow interventions (eg, a fan directed at the cheek), standard supplemental oxygen for patients with hypoxemia, and other psychoeducational, self-management, or complementary approaches. For patients who derive inadequate relief from nonpharmacologic interventions, systemic opioids should be offered. Other pharmacologic interventions, such as corticosteroids and benzodiazepines, are also discussed. Additional information is available at www.asco.org/supportive-care-guidelines.
AB - PURPOSE To provide guidance on the clinical management of dyspnea in adult patients with advanced cancer. METHODS ASCO convened an Expert Panel to review the evidence and formulate recommendations. An Agency for Healthcare Research and Quality (AHRQ) systematic review provided the evidence base for nonpharmacologic and pharmacologic interventions to alleviate dyspnea. The review included randomized controlled trials (RCTs) and observational studies with a concurrent comparison group published through early May 2020. The ASCO Expert Panel also wished to address dyspnea assessment, management of underlying conditions, and palliative care referrals, and for these questions, an additional systematic review identified RCTs, systematic reviews, and guidelines published through July 2020. RESULTS The AHRQ systematic review included 48 RCTs and two retrospective cohort studies. Lung cancer and mesothelioma were the most commonly addressed types of cancer. Nonpharmacologic interventions such as fans provided some relief from breathlessness. Support for pharmacologic interventions was limited. A meta-analysis of specialty breathlessness services reported improvements in distress because of dyspnea. RECOMMENDATIONS A hierarchical approach to dyspnea management is recommended, beginning with dyspnea assessment, ascertainment and management of potentially reversible causes, and referral to an interdisciplinary palliative care team. Nonpharmacologic interventions that may be offered to relieve dyspnea include airflow interventions (eg, a fan directed at the cheek), standard supplemental oxygen for patients with hypoxemia, and other psychoeducational, self-management, or complementary approaches. For patients who derive inadequate relief from nonpharmacologic interventions, systemic opioids should be offered. Other pharmacologic interventions, such as corticosteroids and benzodiazepines, are also discussed. Additional information is available at www.asco.org/supportive-care-guidelines.
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U2 - 10.1200/JCO.20.03465
DO - 10.1200/JCO.20.03465
M3 - Review article
C2 - 33617290
AN - SCOPUS:85104900521
SN - 0732-183X
VL - 39
SP - 1389
EP - 1411
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 12
ER -