Management of dyspnea in advanced cancer: ASCO Guideline Guidelines


Authors: Hui, D.; Bohlke, K.; Bao, T.; Campbell, T. C.; Coyne, P. J.; Currow, D. C.; Gupta, A.; Leiser, A. L.; Mori, M.; Nava, S.; Reinke, L. F.; Roeland, E. J.; Seigel, C.; Walsh, D.; Campbell, M. L.
Title: Management of dyspnea in advanced cancer: ASCO Guideline
Abstract: 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.
Journal Title: Journal of Clinical Oncology
Volume: 39
Issue: 12
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2021-04-20
Start Page: 1389
End Page: 1411
Language: English
DOI: 10.1200/jco.20.03465
PUBMED: 33617290
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 1 June 2021 -- Source: Scopus
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